Provider Demographics
NPI:1548702772
Name:FOX, TAYLOR CHRISTIAN (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:CHRISTIAN
Last Name:FOX
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 CENTER GROVE RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2007
Mailing Address - Country:US
Mailing Address - Phone:973-328-5256
Mailing Address - Fax:973-328-5330
Practice Address - Street 1:214 CENTER GROVE RD
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2007
Practice Address - Country:US
Practice Address - Phone:973-328-5256
Practice Address - Fax:973-328-5330
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT0023007002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer