Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 0273571 | NY |
Y | 225100000X | Physical Therapist | PT020116 | PA |
NPI | 1194700849 |
---|---|
Provider Name | Jeffrey Taylor |
First Address | Sayre, PA 18840-1625 |
Second Address | Sayre, PA 18840-1625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 18/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02683741 | (05) | NY |
101384523 | (05) | PA |