Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 3566 | NE |
N | 2251S0007X | Physical Therapist - Sports | 3566 | NE |
NPI | 1053787085 |
---|---|
Provider Name | Mr. Taylor Gregory Majerus |
First Address | Clovis, NM 88101-3125 |
Second Address | Cannon Afb, NM 88101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2015 |
Last Update Date | 24/09/2021 |