Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 4829 | NM |
Y | 2251P0200X | Physical Therapist - Pediatrics | 042741 | NY |
NPI | 1073060901 |
---|---|
Provider Name | Julie Taylor |
First Address | Buffalo, NY 14203-1002 |
Second Address | Buffalo, NY 14203-1002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2016 |
Last Update Date | 02/05/2019 |