MEDICARE: TAYLOR THOMASON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22	OTHER		RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDER

General Provider Information

NPI Number	:	1093114084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR THOMASON

Provider Business Mailing Address
First Line	:	14813 WEDGEWOOD DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-1528
Country	:	US
Telephone Number	:	813-760-9406
Fax Number	:

Provider Business Practice Location Address
First Line	:	14813 WEDGEWOOD DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-1528
Country	:	US
Telephone Number	:	813-760-9406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2014
Last Update Date	:	08/15/2014

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Directions to “ TAYLOR THOMASON ” Practice Location

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