Healthcare Provider Details

I. General information

NPI: 1972443638
Provider Name (Legal Business Name): TAYLOR TILLINGHAST CMT, CPT, CES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 SAN RAMON VALLEY BLVD STE 115
SAN RAMON CA
94583-1788
US

IV. Provider business mailing address

1139 WESTMORELAND CIR
WALNUT CREEK CA
94596-6334
US

V. Phone/Fax

Practice location:
  • Phone: 925-413-5542
  • Fax:
Mailing address:
  • Phone: 925-413-5542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number77028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: