Provider Demographics
NPI:1013979046
Name:TAYLOR, ERIC ANTHONY (ATC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ANTHONY
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12889 W GOLDENBROOK CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1444
Mailing Address - Country:US
Mailing Address - Phone:208-350-9626
Mailing Address - Fax:208-939-1420
Practice Address - Street 1:12400 W MCMILLAN RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-0529
Practice Address - Country:US
Practice Address - Phone:208-340-0753
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-0712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID2255A2300XMedicare UPIN