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General NPI Number Information
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NPI Number | 1346501962
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Entity Type | Individual
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Provider Name | JEFFREY R TAYLOR DPT
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Gender | Male
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 2056 S. EAGLE RD
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City | MERIDIAN
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State | ID
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Zip | 83642-2462
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Country | US
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Telephone | 208-906-8469
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Fax |
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Provider Business Mailing Address
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Address Line | 2056 S. EAGLE RD
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City | MERIDIAN
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State | ID
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Zip | 83642-2462
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Country | US
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Telephone | 208-906-8469
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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 | PT-2983
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License Number State | ID
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