Provider Demographics
NPI:1356750244
Name:TAYLOR, JASON DANIEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DANIEL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3344 PINE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-8936
Mailing Address - Country:US
Mailing Address - Phone:541-236-2123
Mailing Address - Fax:888-706-1637
Practice Address - Street 1:2312 S 6TH ST STE B
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-4340
Practice Address - Country:US
Practice Address - Phone:541-236-2123
Practice Address - Fax:888-706-1637
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR61778OtherSTATE OF OREGON PHYSICAL THERAPIST LICENSING BOARD