Healthcare Provider Details

I. General information

NPI: 1063603736
Provider Name (Legal Business Name): MR. WILLIAM CHRISTOPHER TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CAMP JOY RD
INTERLACHEN FL
32148-5054
US

IV. Provider business mailing address

130 CAMP JOY RD
INTERLACHEN FL
32148-5054
US

V. Phone/Fax

Practice location:
  • Phone: 352-262-9503
  • Fax:
Mailing address:
  • Phone: 352-262-9503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA50451
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: