Provider Demographics
NPI:1043558406
Name:TAYLOR, JEFFREY BLAIR (PTA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BLAIR
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 LACKAWANNA ST
Mailing Address - Street 2:APT 6-8
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-1551
Mailing Address - Country:US
Mailing Address - Phone:610-396-1121
Mailing Address - Fax:
Practice Address - Street 1:500 PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-2764
Practice Address - Country:US
Practice Address - Phone:610-796-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-19
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003091225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant