Provider Demographics
NPI:1861550709
Name:TAYLOR, OLIVIA ANN (MPT, DPT)
Entity type:Individual
Prefix:MISS
First Name:OLIVIA
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 GUM BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-8227
Mailing Address - Country:US
Mailing Address - Phone:910-389-6749
Mailing Address - Fax:370-324-4325
Practice Address - Street 1:7011 GUM BRANCH RD
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28574-8227
Practice Address - Country:US
Practice Address - Phone:910-389-6749
Practice Address - Fax:370-324-4325
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212203Medicaid