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General NPI Number Information
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NPI Number | 1053964148
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Entity Type | Individual
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Provider Name | STEPHEN ANDREW TAYLOR AT
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Gender | Male
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 4665 BLUE PLAINS DR SW
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City | WASHINGTON
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State | DC
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Zip | 20032-5202
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Country | US
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Telephone | 202-645-6669
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Fax |
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Provider Business Mailing Address
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Address Line | 625 E MONROE AVE APT 210
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City | ALEXANDRIA
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State | VA
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Zip | 22301-3023
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Country | US
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Telephone | 727-735-7123
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000007101
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License Number State | OH
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