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General NPI Number Information
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NPI Number | 1497431514
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Entity Type | Individual
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Provider Name | TAYLOR WILLIAM LESAGE
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Gender | Male
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Dates
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Enumeration Date | 06/23/2023
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 2245 CAMINO VIDA ROBLE
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City | CARLSBAD
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State | CA
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Zip | 92011-1557
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Country | US
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Telephone | 760-683-8959
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Fax |
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Provider Business Mailing Address
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Address Line | 1838 RED WILLOW WAY
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City | OCEANSIDE
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State | CA
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Zip | 92056-6454
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Country | US
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Telephone |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 52589
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License Number State | CA
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