Healthcare Provider Details

I. General information

NPI: 1558399386
Provider Name (Legal Business Name): REBECCA LYNNE TAYLOR MS, ATC, PES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 IRVING ST NW
WASHINGTON DC
20010-2921
US

IV. Provider business mailing address

449 BERRY CT
TANEYTOWN MD
21787-2368
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-1760
  • Fax:
Mailing address:
  • Phone: 302-270-6584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: