Provider Demographics
NPI:1144401068
Name:TAYLOR, JEFFREY SCOTT (MPT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907A HETHER ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-3319
Mailing Address - Country:US
Mailing Address - Phone:512-326-9923
Mailing Address - Fax:512-326-9925
Practice Address - Street 1:1907A HETHER ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-3319
Practice Address - Country:US
Practice Address - Phone:512-326-9923
Practice Address - Fax:512-326-9925
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1163819225100000X
FL14602225100000X
CO7159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist