Provider Demographics
NPI:1942055199
Name:LUIZ, TAYLOR RAE (LPMT, MT-BC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RAE
Last Name:LUIZ
Suffix:
Gender:F
Credentials:LPMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGHLAND PARK TRL APT 602
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3389
Mailing Address - Country:US
Mailing Address - Phone:706-748-1941
Mailing Address - Fax:
Practice Address - Street 1:1001 MACY DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-6335
Practice Address - Country:US
Practice Address - Phone:706-748-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMUT000331225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist