Provider Demographics
NPI:1417519141
Name:TAYLOR, JASON (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 AVIAN DR
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-4128
Mailing Address - Country:US
Mailing Address - Phone:518-322-8080
Mailing Address - Fax:
Practice Address - Street 1:1 DOT WAY
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:IL
Practice Address - Zip Code:62353-1664
Practice Address - Country:US
Practice Address - Phone:217-773-4411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer