Provider Demographics
NPI:1942669163
Name:FELDERHOFF, TAYLOR (ATC, MAT, LAT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:FELDERHOFF
Suffix:
Gender:F
Credentials:ATC, MAT, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 AUBURN ST APT 2135
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-1493
Mailing Address - Country:US
Mailing Address - Phone:940-727-9755
Mailing Address - Fax:
Practice Address - Street 1:5202 AUBURN ST APT 2135
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-1493
Practice Address - Country:US
Practice Address - Phone:940-727-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer