MEDICARE: TAYLOR LYNN HANTGIN

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		CO

General Provider Information

NPI Number	:	1093578981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR LYNN HANTGIN

Provider Business Mailing Address
First Line	:	1010 W MULBERRY ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-3517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 W MULBERRY ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-3517
Country	:	US
Telephone Number	:	805-722-0928
Fax Number	:

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

Provider Enumeration Date	:	02/02/2024
Last Update Date	:	02/02/2024

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