Provider Demographics
NPI:1497643191
Name:DEFREITAS, TAYLOR DANIELLE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DANIELLE
Last Name:DEFREITAS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:DEFREITAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1024 SECRETARIAT DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-9228
Mailing Address - Country:US
Mailing Address - Phone:803-370-1630
Mailing Address - Fax:
Practice Address - Street 1:1024 SECRETARIAT DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-9228
Practice Address - Country:US
Practice Address - Phone:803-370-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist