Provider Demographics
NPI:1740486935
Name:TAYLOR, ANTHONY CHARLES (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:CHARLES
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 DODGE ST
Mailing Address - Street 2:FH 024
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68182-1102
Mailing Address - Country:US
Mailing Address - Phone:402-594-4953
Mailing Address - Fax:
Practice Address - Street 1:6001 DODGE ST
Practice Address - Street 2:FH 024
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68182-1102
Practice Address - Country:US
Practice Address - Phone:402-594-4953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005832255A2300X
NE6632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer