1922318880 NPI number — MISS SUMMER L TAYLOR D.P.T

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922318880 NPI number — MISS SUMMER L TAYLOR D.P.T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
SUMMER
Provider Middle Name:
L
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
D.P.T
Provider Gender Code:
F

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:
1922318880
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 242757
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36124-2757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-396-3273
Provider Business Mailing Address Fax Number:
334-396-4905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5320 HIGHWAY 90 W
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36619-4202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-445-7901
Provider Business Practice Location Address Fax Number:
251-660-8348
Provider Enumeration Date:
10/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PTH5138 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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