Provider Demographics
NPI:1952846800
Name:TAYLOR, RICHARD EDWARD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWARD
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 LLOYD STEWART RD
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:NC
Mailing Address - Zip Code:27505-9089
Mailing Address - Country:US
Mailing Address - Phone:919-343-8836
Mailing Address - Fax:
Practice Address - Street 1:1080 LLOYD STEWART RD
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:NC
Practice Address - Zip Code:27505-9089
Practice Address - Country:US
Practice Address - Phone:919-343-8836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC333766522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer