Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 383 | MT |
NPI | 1184845414 |
---|---|
Provider Name | Mr. Jon Mark Taylor |
First Address | Missoula, MT 59801-2814 |
Second Address | Missoula, MT 59803-1163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |