Provider Demographics
NPI:1003496811
Name:OVERTON, TAYLOR JAMES (MAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JAMES
Last Name:OVERTON
Suffix:
Gender:M
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 72ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2102
Mailing Address - Country:US
Mailing Address - Phone:972-921-9877
Mailing Address - Fax:
Practice Address - Street 1:2621 DRIVE OF CHAMPIONS
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414
Practice Address - Country:US
Practice Address - Phone:972-775-0519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT65562081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine