Provider Demographics
NPI:1417587171
Name:TAYLOR, MATT BENJAMIN II (ATC)
Entity Type:Individual
Prefix:
First Name:MATT
Middle Name:BENJAMIN
Last Name:TAYLOR
Suffix:II
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:BENJAMIN
Other - Last Name:TAYLOR
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:3814 MORDECAI LN
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-2008
Mailing Address - Country:US
Mailing Address - Phone:251-295-4176
Mailing Address - Fax:
Practice Address - Street 1:3814 MORDECAI LN
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-2008
Practice Address - Country:US
Practice Address - Phone:251-295-4176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20000378562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer