Healthcare Provider Details

I. General information

NPI: 1114656444
Provider Name (Legal Business Name): PATRICK TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 E HOUSTON ST STE 102
SAN ANTONIO TX
78205-2126
US

IV. Provider business mailing address

1116 E HOUSTON ST STE 102
SAN ANTONIO TX
78205-2126
US

V. Phone/Fax

Practice location:
  • Phone: 830-388-0830
  • Fax:
Mailing address:
  • Phone: 830-388-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: