MEDICARE: DR. WESLEY MATTHEW TAYLOR 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	003376	WV

General Provider Information

NPI Number	:	1972911071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WESLEY MATTHEW TAYLOR DPT

Provider Business Mailing Address
First Line	:	39 MADDEX DR
Second Line	:
City	:	SHEPHERDSTOWN
State	:	WV
Zip	:	25443-4322
Country	:	US
Telephone Number	:	304-876-8600
Fax Number	:	304-876-8601

Provider Business Practice Location Address
First Line	:	39 MADDEX DR
Second Line	:
City	:	SHEPHERDSTOWN
State	:	WV
Zip	:	25443-4322
Country	:	US
Telephone Number	:	304-876-8600
Fax Number	:	304-876-8601

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

Provider Enumeration Date	:	08/01/2014
Last Update Date	:	08/01/2014

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