Provider Demographics
NPI:1669334561
Name:TAYLOR, AUDREY
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:TAYLOR
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 1:11365 S BIG SKY DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-7017
Mailing Address - Country:US
Mailing Address - Phone:260-602-6567
Mailing Address - Fax:
Practice Address - Street 1:9221 S REDWOOD RD STE B
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5803
Practice Address - Country:US
Practice Address - Phone:801-949-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-29
Last Update Date:2025-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13982676-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist