Provider Demographics
NPI:1225601545
Name:TAYLOR, JUSTIN PAUL
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:PAUL
Last Name:TAYLOR
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 1:750 ROWLESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:OH
Mailing Address - Zip Code:45686-8838
Mailing Address - Country:US
Mailing Address - Phone:740-612-7092
Mailing Address - Fax:
Practice Address - Street 1:750 ROWLESVILLE RD
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:OH
Practice Address - Zip Code:45686-8838
Practice Address - Country:US
Practice Address - Phone:740-612-7092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program