Healthcare Provider Details

I. General information

NPI: 1205484029
Provider Name (Legal Business Name): TAYLOR ZUBERER MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 CENTRAL AVE
LOUISVILLE KY
40208-1449
US

IV. Provider business mailing address

9103 FOX CHASE RD
LOUISVILLE KY
40228-2580
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-8700
  • Fax:
Mailing address:
  • Phone: 502-994-4869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberAT1288
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: