Provider Demographics
NPI:1851517874
Name:TAYLOR, SCOTT BARRY (MST)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:BARRY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 CAPITOLA AVE STE H
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2777
Mailing Address - Country:US
Mailing Address - Phone:831-818-0036
Mailing Address - Fax:
Practice Address - Street 1:1685 SOQUEL DR.
Practice Address - Street 2:SUITE H
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065
Practice Address - Country:US
Practice Address - Phone:831-464-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10199225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist