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General NPI Number Information
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NPI Number | 1134374796
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Entity Type | Individual
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Provider Name | MARK DONAVON TAYLOR DPT
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Gender | Male
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 260 FALLS AVE
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City | TWIN FALLS
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State | ID
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Zip | 83301-3370
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Country | US
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Telephone | 208-410-9611
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Fax |
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Provider Business Mailing Address
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Address Line | 3318 OREGON TRAIL LN
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City | KIMBERLY
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State | ID
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Zip | 83341-5349
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Country | US
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Telephone | 208-410-9611
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 7543632-2401
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11504-24
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-2421
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License Number State | ID
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