Provider Demographics
NPI:1003683442
Name:POWELL-REES, TAYLOR T
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:T
Last Name:POWELL-REES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-4806
Mailing Address - Country:US
Mailing Address - Phone:208-242-7005
Mailing Address - Fax:
Practice Address - Street 1:350 4TH AVE W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5815
Practice Address - Country:US
Practice Address - Phone:208-240-6058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care