Provider Demographics
NPI:1174018113
Name:ETCHART, TAYLOR BRYANT
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BRYANT
Last Name:ETCHART
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 1:7217 N FIVE MILE RD APT 7
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-3600
Mailing Address - Country:US
Mailing Address - Phone:805-234-5961
Mailing Address - Fax:
Practice Address - Street 1:7040 , 3209 E 57TH AVE
Practice Address - Street 2:SUITE H
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223
Practice Address - Country:US
Practice Address - Phone:509-448-9398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60859024225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist