1093368623 NPI number — TAYLORED THERAPIES, PLLC

Table of content: (NPI 1093368623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093368623 NPI number — TAYLORED THERAPIES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAYLORED THERAPIES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093368623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 WEBBLY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLA VISTA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72714-2909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-903-3488
Provider Business Mailing Address Fax Number:
855-738-7702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1004 BEAU TERRE DR STE 507
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTONVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72712-6799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-903-1018
Provider Business Practice Location Address Fax Number:
855-738-7702
Provider Enumeration Date:
07/23/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
479-903-1018

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)