Provider Demographics
NPI:1588250997
Name:BORYCA, TAYLOR KRISTEN
Entity type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:KRISTEN
Last Name:BORYCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 ARROWHEAD LN
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4614
Mailing Address - Country:US
Mailing Address - Phone:757-412-9979
Mailing Address - Fax:
Practice Address - Street 1:2707 ARROWHEAD LN
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4614
Practice Address - Country:US
Practice Address - Phone:757-412-9979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1905225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant