Provider Demographics
NPI:1912264607
Name:TAYLOR, JASON SCOTT (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:SCOTT
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CALVETT PL
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9489
Mailing Address - Country:US
Mailing Address - Phone:570-837-9305
Mailing Address - Fax:
Practice Address - Street 1:500 N BROAD ST
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-1665
Practice Address - Country:US
Practice Address - Phone:570-374-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0034822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer