Provider Demographics
NPI:1730825639
Name:VANDERWERFF, TAYLOR JEAN (LAT, ATC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JEAN
Last Name:VANDERWERFF
Suffix:
Gender:F
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 1:4401 GARTH RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2122
Mailing Address - Country:US
Mailing Address - Phone:281-420-8600
Mailing Address - Fax:
Practice Address - Street 1:4401 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2122
Practice Address - Country:US
Practice Address - Phone:281-420-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COBOC3273172255A2300X
TXAT80222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer