Provider Demographics
NPI:1548659816
Name:JONARD, TAYLOR MASON (PT)
Entity type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:MASON
Last Name:JONARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10405 CENTER VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-9400
Mailing Address - Country:US
Mailing Address - Phone:614-738-1017
Mailing Address - Fax:
Practice Address - Street 1:9540 TOWNE CENTRE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1988
Practice Address - Country:US
Practice Address - Phone:800-585-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH015148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist