Provider Demographics
NPI:1750318630
Name:TAYLOR, ANGIE M (MS, LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 BRAYBROOKE PL.
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5993
Mailing Address - Country:US
Mailing Address - Phone:910-339-4993
Mailing Address - Fax:
Practice Address - Street 1:3308 MELROSE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1604
Practice Address - Country:US
Practice Address - Phone:910-484-3114
Practice Address - Fax:910-484-8824
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer