Provider Demographics
NPI:1821184680
Name:TAYLOR, RAY (PT)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:205 30TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2308
Mailing Address - Country:US
Mailing Address - Phone:310-800-0835
Mailing Address - Fax:
Practice Address - Street 1:2615 PACIFIC COAST HWY STE 321
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2227
Practice Address - Country:US
Practice Address - Phone:310-798-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist