Active NPI
Taylor Pavlak, DPT
- Physical Therapist
- Columbia, IL
National Provider Identifier
1265089924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070024614
- Practice address
- 1000 Eleven S Ste 1B
Columbia, IL 62236-1078 - Phone
- (618) 550-9107
- NPI assigned
- Aug 19, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070024614 | IL | Primary |
Addresses
Primary practice location
1000 Eleven S Ste 1B
Columbia, IL 62236-1078
Mailing address
326 Meadowlark LN
Belleville, IL 62220-2784
Phone (618) 550-9107
Other practice location 1
1 Professional Dr Ste 10
Alton, IL 62002-5068
Phone (618) 462-4621
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608595200000",
"number": "1265089924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "326 MEADOWLARK LN",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622202784",
"telephone_number": "618-550-9107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 ELEVEN S STE 1B",
"city": "COLUMBIA",
"state": "IL",
"postal_code": "622361078",
"telephone_number": "618-550-9107"
}
],
"practiceLocations": [
{
"address_1": "1 Professional Dr Ste 10",
"address_purpose": "LOCATION",
"city": "Alton",
"state": "IL",
"postal_code": "620025068",
"country_code": "US",
"telephone_number": "618-462-4621",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PAVLAK",
"first_name": "TAYLOR",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-19",
"last_updated": "2020-12-22",
"certification_date": "2020-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070024614",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.