MEDICARE: COLLIN MICHAEL TAYLOR PT

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

General Provider Information

NPI Number	:	1720712706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLIN MICHAEL TAYLOR PT

Provider Business Mailing Address
First Line	:	225 I ST
Second Line	:
City	:	CRESCENT CITY
State	:	CA
Zip	:	95531-4305
Country	:	US
Telephone Number	:	707-464-9511
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 I ST
Second Line	:
City	:	CRESCENT CITY
State	:	CA
Zip	:	95531-4305
Country	:	US
Telephone Number	:	707-464-9511
Fax Number	:

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

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	07/14/2022

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Directions to “ COLLIN MICHAEL TAYLOR PT” Practice Location

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