Taylor Susdorf, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

296318 Issued in CA

Practice address

24271 Jackson Ave
Murrieta, CA 92562-1993

Phone

(925) 640-6240

NPI assigned

May 10, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Taylor Sepulevda Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1336885672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41604 BIG SAGE CT",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925911547",
            "telephone_number": "951-252-7928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24271 JACKSON AVE",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925621993",
            "telephone_number": "925-640-6240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSDORF",
        "first_name": "TAYLOR",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-10",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "296318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAYLOR",
            "last_name": "SEPULEVDA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Murrieta, CA
• Providers in Murrieta, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.