Provider Demographics
NPI:1609488055
Name:KOUDELA, TAYLOR (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:
Last Name:KOUDELA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:DARILEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:248 WISTERIA LN
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-2545
Mailing Address - Country:US
Mailing Address - Phone:979-648-2628
Mailing Address - Fax:
Practice Address - Street 1:248 WISTERIA LN
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-2545
Practice Address - Country:US
Practice Address - Phone:979-648-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1334251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist