Basic Information
Provider Information
NPI: 1346591997
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TAYLOR
FirstName: NATALIE
MiddleName: SYLVIA
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 600 CENTRAL AVE STE C
Address2:  
City: LAKE ELSINORE
State: CA
PostalCode: 925302740
CountryCode: US
TelephoneNumber: 9516969353
FaxNumber: 9519737216
Practice Location
Address1: 1280 CORONA POINTE CT STE 101
Address2:  
City: CORONA
State: CA
PostalCode: 928791770
CountryCode: US
TelephoneNumber: 9513403402
FaxNumber: 9513403416
Other Information
ProviderEnumerationDate: 09/23/2012
LastUpdateDate: 10/14/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/14/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT 39069CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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