Provider Demographics
NPI:1063946903
Name:JUMP, TAYLOR L (DPT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:L
Last Name:JUMP
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:20320 N JOHN WAYNE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-2936
Practice Address - Country:US
Practice Address - Phone:520-635-2260
Practice Address - Fax:520-564-3758
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT292965225100000X
WAPT60765888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB273960Medicare PIN
CACA244116Medicare PIN