Provider Demographics
NPI:1013326073
Name:ANGUIANO, TAYLOR KATELYN (ATC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:KATELYN
Last Name:ANGUIANO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 E MALLARD DR
Mailing Address - Street 2:#140
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6666
Mailing Address - Country:US
Mailing Address - Phone:714-904-2447
Mailing Address - Fax:
Practice Address - Street 1:185 E MALLARD DR
Practice Address - Street 2:#140
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6666
Practice Address - Country:US
Practice Address - Phone:714-904-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA452272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer