Healthcare Provider Details

I. General information

NPI: 1124543590
Provider Name (Legal Business Name): MICHELLE TAYLOR ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12909 E 120TH AVE
HENDERSON CO
80640-9146
US

IV. Provider business mailing address

16365 E 99TH AVE
COMMERCE CITY CO
80022-7114
US

V. Phone/Fax

Practice location:
  • Phone: 303-655-8892
  • Fax:
Mailing address:
  • Phone: 303-472-7354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number509
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: