Provider Demographics
NPI:1023495165
Name:TAYLOR MASSAGE
Entity type:Organization
Organization Name:TAYLOR MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:352-317-4755
Mailing Address - Street 1:815 N JEFFERSON ST
Mailing Address - Street 2:APT. 204
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-2174
Mailing Address - Country:US
Mailing Address - Phone:352-317-4755
Mailing Address - Fax:
Practice Address - Street 1:815 N JEFFERSON ST
Practice Address - Street 2:APT. 204
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-2174
Practice Address - Country:US
Practice Address - Phone:352-317-4755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA75029225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty