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NPI Code Detail

MEDICARE: TAALOR STEVENSON

MEDICARE:   TAALOR  STEVENSON
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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1366069395
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAALOR STEVENSON
Provider Business Mailing Address
First Line : 5820 WATERFRONT DR N
Second Line :
City : COLUMBIA
State : MO
Zip : 65202-9052
Country : US
Telephone Number : 573-673-4896
Fax Number :
Provider Business Practice Location Address
First Line : 10 W NIFONG BLVD
Second Line :
City : COLUMBIA
State : MO
Zip : 65203-6011
Country : US
Telephone Number : 573-442-5268
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2020
Last Update Date : 06/25/2020

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Directions to “ TAALOR STEVENSON ” Practice Location

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