Provider Demographics
NPI:1316057300
Name:TAYLOR, MARIA CONCEPCION BAUTISTA (DPT,CEEAA CDP)
Entity type:Individual
Prefix:
First Name:MARIA CONCEPCION
Middle Name:BAUTISTA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DPT,CEEAA CDP
Other - Prefix:
Other - First Name:MARIA CONCEPCION
Other - Middle Name:ALBANO
Other - Last Name:BAUTISTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2682 NATTA BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710
Mailing Address - Country:US
Mailing Address - Phone:718-916-0744
Mailing Address - Fax:718-858-3229
Practice Address - Street 1:2682 NATTA BLVD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710
Practice Address - Country:US
Practice Address - Phone:718-916-0744
Practice Address - Fax:718-858-3229
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ24S41Medicare ID - Type Unspecified