Nicole Marie Taylor, D.P.T.
Individual provider Active NPI Physical Therapist · Aledo, IL
NPI 1295076172 · NPPES record last updated Mar 2, 2020
Key facts
- NPI
- 1295076172
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070019749 (IL)
- Practice address
- 1020 240TH St
Aledo, IL 61231-8536 - Phone
- (309) 373-8330
- NPI assigned
- Mar 2, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200507001721 | IL | Practitioner - Physical Therapist in Private Practice | 6507297546 | Practice locations: Aledo, IL |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070019749 | IL | Yes |
Addresses
Primary practice location
1020 240TH St
Aledo, IL 61231-8536
Mailing address
1020 240TH St
Aledo, IL 61231-8536
Phone (309) 373-8330
Other providers in Aledo, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.