Provider Demographics
NPI:1245618818
Name:TAYLOR, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
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 1:10000 SHANNONDELL DR
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-5615
Mailing Address - Country:US
Mailing Address - Phone:610-382-6849
Mailing Address - Fax:
Practice Address - Street 1:10000 SHANNONDELL DR
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19403-5615
Practice Address - Country:US
Practice Address - Phone:610-382-6849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI004001225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant