Provider Demographics
NPI:1770946584
Name:TAYLOR, SAMANTHA BETHANY (ATC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:BETHANY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7277
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56321-7277
Mailing Address - Country:US
Mailing Address - Phone:320-363-3813
Mailing Address - Fax:320-363-3130
Practice Address - Street 1:2585 ABBEY ROAD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:MN
Practice Address - Zip Code:56321
Practice Address - Country:US
Practice Address - Phone:320-363-3813
Practice Address - Fax:320-363-3130
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer