Basic Information
| Provider Information | |||||||||
| NPI: | 1679018147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLARD | ||||||||
| FirstName: | TAYLOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 KEELER ST | ||||||||
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| City: | LANTANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762267393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403957353 | ||||||||
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| Practice Location | |||||||||
| Address1: | 915 W EXCHANGE PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750137018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145471571 | ||||||||
| FaxNumber: | 8663414918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2016 | ||||||||
| LastUpdateDate: | 02/07/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1287712 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.