Provider Demographics
NPI:1225621915
Name:GAINES, TAYLOR RAE ANN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RAE ANN
Last Name:GAINES
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17331 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3562
Mailing Address - Country:US
Mailing Address - Phone:313-400-4119
Mailing Address - Fax:
Practice Address - Street 1:444 APPLEYARD DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-2815
Practice Address - Country:US
Practice Address - Phone:313-400-4119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer