Provider Demographics
NPI:1114797644
Name:TAYLOR, AMBER ROSE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ROSE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:COLLEGEDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37315-0919
Mailing Address - Country:US
Mailing Address - Phone:423-396-2100
Mailing Address - Fax:
Practice Address - Street 1:5006 UNIVERSITY DR W STE 1200
Practice Address - Street 2:
Practice Address - City:COLLEGEDALE
Practice Address - State:TN
Practice Address - Zip Code:37315-5006
Practice Address - Country:US
Practice Address - Phone:423-396-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMT13019225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist