Provider Demographics
NPI:1902199128
Name:TAYLOR, DOUGLAS CARPENTER (LMP)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:CARPENTER
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6900
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98417-0386
Mailing Address - Country:US
Mailing Address - Phone:253-468-0305
Mailing Address - Fax:253-752-4250
Practice Address - Street 1:7406 27TH ST W STE 23
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4637
Practice Address - Country:US
Practice Address - Phone:253-498-0305
Practice Address - Fax:253-752-4250
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60213376225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist