Provider Demographics
NPI:1275350035
Name:FEENSTRA, TAYLOR J (DPT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:J
Last Name:FEENSTRA
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 1:17660 WRIGHT ST STE 9
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2168
Mailing Address - Country:US
Mailing Address - Phone:402-933-4027
Mailing Address - Fax:402-933-5027
Practice Address - Street 1:17660 WRIGHT ST STE 9
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2168
Practice Address - Country:US
Practice Address - Phone:402-933-4027
Practice Address - Fax:402-933-5027
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist