Provider Demographics
NPI:1144713892
Name:BASTIAN, TAYLOR A (DPT)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:A
Last Name:BASTIAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:TAYLOR
Other - Middle Name:A
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TAYLOR A YOUNG
Mailing Address - Street 1:5111 N RHETT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-4219
Mailing Address - Country:US
Mailing Address - Phone:843-804-9033
Mailing Address - Fax:843-804-9020
Practice Address - Street 1:142 SPORTSMAN ISLAND DR STE F
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-8524
Practice Address - Country:US
Practice Address - Phone:843-377-8820
Practice Address - Fax:843-377-8823
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist