Provider Demographics
NPI:1861914145
Name:TAYLOR, WILLIAM BROOKS (PT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BROOKS
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2069 LAKE PARK DR SE APT C
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8930
Mailing Address - Country:US
Mailing Address - Phone:901-570-0367
Mailing Address - Fax:
Practice Address - Street 1:335 ROSELANE ST NW STE 201
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7902
Practice Address - Country:US
Practice Address - Phone:770-514-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-08
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32659225100000X
TN10825225100000X
GA013362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist