Basic Information
| Provider Information | |||||||||
| NPI: | 1578238150 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLOCKEN | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5293 MORGAN RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325708573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8503242327 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1230 N FALL CREEK RD | ||||||||
| Address2: | |||||||||
| City: | WILSON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 830145058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076997667 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2021 | ||||||||
| LastUpdateDate: | 08/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.