Basic Information
| Provider Information | |||||||||
| NPI: | 1639737661 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1693 N 400 W APT F203 | ||||||||
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| City: | LOGAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843412090 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 267 N SPRING CREEK PKWY | ||||||||
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| City: | PROVIDENCE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 843329775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357929400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2019 | ||||||||
| LastUpdateDate: | 06/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 10864868-2401 | UT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.