Basic Information
Provider Information | |||||||||
NPI: | 1407347388 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BLACK | ||||||||
FirstName: | TAYLOR | ||||||||
MiddleName: | NICOLE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CAVE | ||||||||
OtherFirstName: | TAYLOR | ||||||||
OtherMiddleName: | NICOLE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DPT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 563 UNIVERSITY BLVD | ||||||||
Address2: |   | ||||||||
City: | HARRISONBURG | ||||||||
State: | VA | ||||||||
PostalCode: | 228013752 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5405341338 | ||||||||
FaxNumber: | 5403012778 | ||||||||
Practice Location | |||||||||
Address1: | 563 UNIVERSITY BLVD | ||||||||
Address2: |   | ||||||||
City: | HARRISONBURG | ||||||||
State: | VA | ||||||||
PostalCode: | 228013752 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5405341338 | ||||||||
FaxNumber: | 5403012778 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/25/2018 | ||||||||
LastUpdateDate: | 03/18/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/18/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305211955 | VA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.