Basic Information
| Provider Information | |||||||||
| NPI: | 1780053181 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | WAYNE | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5747 MEMORIAL GYM | ||||||||
| Address2: | UNIVERSITY OF MAINE - ATHLETIC DEPARTMENT | ||||||||
| City: | ORONO | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075811072 | ||||||||
| FaxNumber: | 2075814474 | ||||||||
| Practice Location | |||||||||
| Address1: | 5747 MEMORIAL GYM | ||||||||
| Address2: | UNIVERSITY OF MAINE - ATHLETIC DEPARTMENT | ||||||||
| City: | ORONO | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044695747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075811072 | ||||||||
| FaxNumber: | 2075814474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2015 | ||||||||
| LastUpdateDate: | 09/16/2015 | ||||||||
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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 | 2255A2300X | AT256 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.