Provider Demographics
NPI:1912017666
Name:TAYLOR, JENNIFER J (MPT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MPT, ATC
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3301 W BROADWAY BUSINESS PARK CT STE F
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-0106
Mailing Address - Country:US
Mailing Address - Phone:573-447-0422
Mailing Address - Fax:573-447-0434
Practice Address - Street 1:3301 W BROADWAY BUSINESS PARK CT STE F
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-0106
Practice Address - Country:US
Practice Address - Phone:573-447-0422
Practice Address - Fax:573-447-0434
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2003022304OtherLICENSE #