Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist |
NPI | 1003282229 |
---|---|
Provider Name | Jeffrey Taylor JR. |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Murrells Inlet, SC 29576-5114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2015 |
Last Update Date | 02/11/2015 |