Healthcare Provider Details

I. General information

NPI: 1881747574
Provider Name (Legal Business Name): DONALD WAYNE TAYLOR I PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E NEWPORT AVE
MILWAUKEE WI
53211-2906
US

IV. Provider business mailing address

6541 N BRAEBURN LN
GLENDALE WI
53209-3323
US

V. Phone/Fax

Practice location:
  • Phone: 414-961-4160
  • Fax:
Mailing address:
  • Phone: 414-352-8250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1512-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: