Provider Demographics
NPI:1891057352
Name:TAGGART, JOSHUA SHEM (MT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:SHEM
Last Name:TAGGART
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14001 E ILIFF AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1405
Mailing Address - Country:US
Mailing Address - Phone:303-745-0803
Mailing Address - Fax:720-306-3758
Practice Address - Street 1:14001 E ILIFF AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1405
Practice Address - Country:US
Practice Address - Phone:303-745-0803
Practice Address - Fax:720-306-3758
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12087225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist