Provider Demographics
NPI:1649064973
Name:BOLL, TAYLOR JEAN
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JEAN
Last Name:BOLL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E GREENFIELD LN UNIT D205
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-6594
Mailing Address - Country:US
Mailing Address - Phone:701-899-1114
Mailing Address - Fax:
Practice Address - Street 1:301 LORRAIN DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0311
Practice Address - Country:US
Practice Address - Phone:701-899-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1367A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant