Healthcare Provider Details

I. General information

NPI: 1003771445
Provider Name (Legal Business Name): TAYLOR SAMUEL QUENZER LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6377 S REVERE PKWY
CENTENNIAL CO
80111-6487
US

IV. Provider business mailing address

6377 S REVERE PKWY STE 250
CENTENNIAL CO
80111-6429
US

V. Phone/Fax

Practice location:
  • Phone: 720-378-4214
  • Fax:
Mailing address:
  • Phone: 720-663-9331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number88-4266830
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: