Provider Demographics
NPI:1346243342
Name:TAYLOR, MICHAEL P (PT, MBA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 JASPER ST SPC 20
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2069
Mailing Address - Country:US
Mailing Address - Phone:949-702-1989
Mailing Address - Fax:
Practice Address - Street 1:123 JASPER ST SPC 20
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2069
Practice Address - Country:US
Practice Address - Phone:949-702-1989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT164502251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT16450Medicare ID - Type UnspecifiedMEDICARE NUMBER/LICENSE