Healthcare Provider Details

I. General information

NPI: 1902915010
Provider Name (Legal Business Name): LARRY TAYLOR P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 N TUSTIN ST
ORANGE CA
92867-5904
US

IV. Provider business mailing address

4230 PARK NEWPORT
NEWPORT BEACH CA
92660-6015
US

V. Phone/Fax

Practice location:
  • Phone: 714-288-8303
  • Fax: 714-744-8153
Mailing address:
  • Phone: 949-813-1699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: