Healthcare Provider Details

I. General information

NPI: 1568059103
Provider Name (Legal Business Name): TAYLOR LAFEVER LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LAKESHORE DR
BIRMINGHAM AL
35229-0001
US

IV. Provider business mailing address

101 LEAF LAKE BLVD APT 616
BIRMINGHAM AL
35211-7255
US

V. Phone/Fax

Practice location:
  • Phone: 423-735-8892
  • Fax:
Mailing address:
  • Phone: 423-735-8892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2457
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: