Provider Demographics
NPI:1013382654
Name:TAYLOR, CHRISTOPHER DREW (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DREW
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13336 INDUSTRIAL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1124
Mailing Address - Country:US
Mailing Address - Phone:402-330-3211
Mailing Address - Fax:402-330-5970
Practice Address - Street 1:13336 INDUSTRIAL RD STE 105
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137
Practice Address - Country:US
Practice Address - Phone:402-330-3211
Practice Address - Fax:402-330-5970
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1263500225100000X
NE3867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$00Medicaid