Basic Information
Provider Information | |||||||||
NPI: | 1487606703 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TAYLOR | ||||||||
FirstName: | CHRIS | ||||||||
MiddleName: | ANNE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BURIK | ||||||||
OtherFirstName: | CHRIS | ||||||||
OtherMiddleName: | ANNE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 518 PELLIS RD | ||||||||
Address2: |   | ||||||||
City: | GREENSBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 156014599 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7248321696 | ||||||||
FaxNumber: | 7248326351 | ||||||||
Practice Location | |||||||||
Address1: | 518 PELLIS RD | ||||||||
Address2: |   | ||||||||
City: | GREENSBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 156014599 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7248321696 | ||||||||
FaxNumber: | 7248326351 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/16/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT000546L | PA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 350432 | 01 | PA | HIGHMARK | OTHER |