Provider Demographics
NPI:1770004707
Name:JORDAN, TAYLOR ANNE (LAT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:ANNE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 MCKELVEY HILL DR APT 303
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-3919
Mailing Address - Country:US
Mailing Address - Phone:704-678-7309
Mailing Address - Fax:
Practice Address - Street 1:1885 MCKELVEY HILL DR.
Practice Address - Street 2:APT 303
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043
Practice Address - Country:US
Practice Address - Phone:704-678-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer