Provider Demographics
NPI:1780428003
Name:TAYLOR, MORGAN D (ATC, LAT)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:F
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 1:3224 JANTON LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-0324
Mailing Address - Country:US
Mailing Address - Phone:314-494-3321
Mailing Address - Fax:
Practice Address - Street 1:14 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1818
Practice Address - Country:US
Practice Address - Phone:314-530-5480
Practice Address - Fax:314-627-1406
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240209902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer