Provider Demographics
NPI:1902681430
Name:PAWLOWSKI, TAYLOR (DPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:PAWLOWSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5799
Mailing Address - Country:US
Mailing Address - Phone:904-829-3411
Mailing Address - Fax:904-829-3412
Practice Address - Street 1:209 BLACKFORD WAY STE A
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-1883
Practice Address - Country:US
Practice Address - Phone:904-907-1122
Practice Address - Fax:904-907-1123
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist