Provider Demographics
NPI:1306811245
Name:TAYLOR, ROBERT JOHN JR (ATC,CSCS,NASM-PES)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOHN
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:ATC,CSCS,NASM-PES
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1949 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9506
Mailing Address - Country:US
Mailing Address - Phone:269-429-8506
Mailing Address - Fax:269-687-0960
Practice Address - Street 1:6 LONG MEADOW VILLAGE LN
Practice Address - Street 2:SUITE 2
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-7808
Practice Address - Country:US
Practice Address - Phone:269-687-0945
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer