Provider Demographics
NPI:1033325451
Name:TAYLOR, NATASHA ANGTUOKUU (PT, MS OCS)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:ANGTUOKUU
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT, MS OCS
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:ANGTUOKUU
Other - Last Name:BACHEYIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MS
Mailing Address - Street 1:1051 N CANTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5097
Mailing Address - Country:US
Mailing Address - Phone:716-523-8116
Mailing Address - Fax:
Practice Address - Street 1:1051 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5097
Practice Address - Country:US
Practice Address - Phone:716-523-8116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026531-1225100000X
NCP10439225100000X
MI55010135002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist