MEDICARE: TAYLOR L JUMP DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT292965	CA
2	225100000X	Physical Therapist	PT60765888	WA

General Provider Information

NPI Number	:	1063946903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR L JUMP DPT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	866-370-8206
Fax Number	:	517-435-3670

Provider Business Practice Location Address
First Line	:	20320 N JOHN WAYNE PKWY STE 120
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85139-2936
Country	:	US
Telephone Number	:	520-635-2260
Fax Number	:	520-564-3758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	12/08/2022

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Directions to “ TAYLOR L JUMP DPT” Practice Location

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