MEDICARE: TAYLOR N OSTENDORF

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	225200000X	Physical Therapy Assistant	PTA28873	FL

General Provider Information

NPI Number	:	1538637541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR N OSTENDORF

Provider Business Mailing Address
First Line	:	984 SE ROSSI DR
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-2399
Country	:	US
Telephone Number	:	386-288-6520
Fax Number	:

Provider Business Practice Location Address
First Line	:	984 SE ROSSI DR
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-3202
Country	:	US
Telephone Number	:	386-288-6520
Fax Number	:

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

Provider Enumeration Date	:	11/07/2018
Last Update Date	:	11/07/2018

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Directions to “ TAYLOR N OSTENDORF ” Practice Location

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