Provider Demographics
NPI:1205329125
Name:TAYLOR, SHIRLEY ROMBOUTS (PT)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ROMBOUTS
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:ANN
Other - Last Name:ROMBOUTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:80 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1055
Mailing Address - Country:US
Mailing Address - Phone:415-722-2357
Mailing Address - Fax:
Practice Address - Street 1:80 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1055
Practice Address - Country:US
Practice Address - Phone:415-722-2357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist