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NPI Code Detail

MEDICARE: DOUGLAS CARPENTER TAYLOR L.M.P.

MEDICARE: DOUGLAS CARPENTER TAYLOR L.M.P.
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
1225700000XMassage TherapistMA60213376WA

General Provider Information

NPI Number : 1902199128
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS CARPENTER TAYLOR L.M.P.
Provider Business Mailing Address
First Line : PO BOX 6900
Second Line :
City : TACOMA
State : WA
Zip : 98417-0386
Country : US
Telephone Number : 253-468-0305
Fax Number : 253-752-4250
Provider Business Practice Location Address
First Line : 7406 27TH ST W STE 23
Second Line :
City : UNIVERSITY PLACE
State : WA
Zip : 98466-4637
Country : US
Telephone Number : 253-498-0305
Fax Number : 253-752-4250
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2011
Last Update Date : 05/20/2011

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