Provider Demographics
NPI:1730651381
Name:TAYLOR, GREGORY ALLAN (MED, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALLAN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14455 CLAY TERRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3605
Mailing Address - Country:US
Mailing Address - Phone:317-415-5795
Mailing Address - Fax:
Practice Address - Street 1:14455 CLAY TERRACE BLVD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3605
Practice Address - Country:US
Practice Address - Phone:317-415-5795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002522A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer