Provider Demographics
NPI:1548649098
Name:TAYLOR, SAM III (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:TAYLOR
Suffix:III
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SAINT JAMES CT
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-9334
Mailing Address - Country:US
Mailing Address - Phone:254-592-2301
Mailing Address - Fax:
Practice Address - Street 1:2008 L DON DODSON DR STE 105
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-1844
Practice Address - Country:US
Practice Address - Phone:817-288-0121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1258109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist