Provider Demographics
NPI:1720712706
Name:TAYLOR, COLLIN MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:MICHAEL
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 1:225 I ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-4305
Mailing Address - Country:US
Mailing Address - Phone:707-464-9511
Mailing Address - Fax:
Practice Address - Street 1:225 I ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-4305
Practice Address - Country:US
Practice Address - Phone:707-464-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist