Provider Demographics
NPI:1902027642
Name:LE, TAYLOR NHU (MPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:NHU
Last Name:LE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 LAURELHURST DR
Mailing Address - Street 2:#159
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-5856
Mailing Address - Country:US
Mailing Address - Phone:916-622-0987
Mailing Address - Fax:
Practice Address - Street 1:3250 LAURELHURST DR
Practice Address - Street 2:#159
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-5856
Practice Address - Country:US
Practice Address - Phone:916-622-0987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 30051171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor