Provider Demographics
NPI:1629661160
Name:TAYLOR, JASON PAUL (PT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:PAUL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:570-575-0168
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:2000 S GLENBURNIE RD STE 210
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5227
Practice Address - Country:US
Practice Address - Phone:252-302-5200
Practice Address - Fax:252-302-2191
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305214143225100000X
NCCP031609T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist