Provider Demographics
NPI:1548713340
Name:STEVENS, TAYLOR CHARLES (ATC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CHARLES
Last Name:STEVENS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 DARMONDALE DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369-8821
Mailing Address - Country:US
Mailing Address - Phone:864-529-8388
Mailing Address - Fax:
Practice Address - Street 1:131 DARMONDALE DR
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:SC
Practice Address - Zip Code:29369-8821
Practice Address - Country:US
Practice Address - Phone:864-529-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer