Provider Demographics
NPI:1861591745
Name:TAYLOR PHYSICAL THERAPY ASSOCIATES LLC
Entity type:Organization
Organization Name:TAYLOR PHYSICAL THERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROD
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:319-352-5644
Mailing Address - Street 1:1306 HIGHWAY 57
Mailing Address - Street 2:STE B
Mailing Address - City:PARKERSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50665-1049
Mailing Address - Country:US
Mailing Address - Phone:319-346-9783
Mailing Address - Fax:319-346-9785
Practice Address - Street 1:1014 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:IA
Practice Address - Zip Code:50674-1273
Practice Address - Country:US
Practice Address - Phone:563-578-5125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00269225100000X
225X00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty