1417070368 NPI number — MR. BRADLEY E TAYLOR M.ED, ATC

Table of content: MR. BRADLEY E TAYLOR M.ED, ATC (NPI 1417070368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417070368 NPI number — MR. BRADLEY E TAYLOR M.ED, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
BRADLEY
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.ED, ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417070368
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 MORNINGMIST LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19363-4314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-932-0960
Provider Business Mailing Address Fax Number:
610-932-0960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 NEUMANN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19014-1277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-358-4235
Provider Business Practice Location Address Fax Number:
610-361-2494
Provider Enumeration Date:
04/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  RT000347A , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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