Healthcare Provider Details

I. General information

NPI: 1053729889
Provider Name (Legal Business Name): TAYLOR BROOKS DOUGLAS RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 PALM COAST PKWY SW SUITE 6/7
PALM COAST FL
32137-4739
US

IV. Provider business mailing address

35 VILLAGE DR
FLAGLER BEACH FL
32136-3484
US

V. Phone/Fax

Practice location:
  • Phone: 386-951-3044
  • Fax: 866-610-0580
Mailing address:
  • Phone: 386-569-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: