Provider Demographics
NPI:1215465240
Name:MATA, TAYLAR (ATC)
Entity type:Individual
Prefix:
First Name:TAYLAR
Middle Name:
Last Name:MATA
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 1:408 W OLD PLANK RD APT 105
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2078
Mailing Address - Country:US
Mailing Address - Phone:682-622-9235
Mailing Address - Fax:
Practice Address - Street 1:8501 FM 407
Practice Address - Street 2:
Practice Address - City:DOUBLE OAK
Practice Address - State:TX
Practice Address - Zip Code:75077-3031
Practice Address - Country:US
Practice Address - Phone:972-966-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-04
Last Update Date:2017-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer