Healthcare Provider Details

I. General information

NPI: 1952762221
Provider Name (Legal Business Name): TAYLOR-MADE INTEGRATIVE HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 N HIGHWAY 27 SUITE A
CLERMONT FL
34711-2400
US

IV. Provider business mailing address

185 N HIGHWAY 27 SUITE A
CLERMONT FL
34711-2400
US

V. Phone/Fax

Practice location:
  • Phone: 352-989-5555
  • Fax: 352-432-2121
Mailing address:
  • Phone: 352-989-5555
  • Fax: 352-432-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRACY HENDERSON
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 513-685-0949