Provider Demographics
NPI:1962994574
Name:TAYLOR, RACHEL LEA (LAT, ATC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SELWYN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28274-0001
Mailing Address - Country:US
Mailing Address - Phone:704-337-2405
Mailing Address - Fax:704-337-2237
Practice Address - Street 1:1900 SELWYN AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28274-0001
Practice Address - Country:US
Practice Address - Phone:704-337-2405
Practice Address - Fax:704-337-2237
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer