Healthcare Provider Details

I. General information

NPI: 1336811579
Provider Name (Legal Business Name): TAYLOR BRIAN NORD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 10/05/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 7TH AVE FL 14
NEW YORK NY
10018-4603
US

IV. Provider business mailing address

309 W 93RD ST APT 1C
NEW YORK NY
10025-7224
US

V. Phone/Fax

Practice location:
  • Phone: 212-768-7979
  • Fax:
Mailing address:
  • Phone: 218-766-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP112255
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: