Provider Demographics
NPI:1023685344
Name:TAYLOR, BRETT (ATC)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W MARTIN LUTHER KING BLVD UNIT 907
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2015
Mailing Address - Country:US
Mailing Address - Phone:620-363-0546
Mailing Address - Fax:
Practice Address - Street 1:800 S MINT ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1640
Practice Address - Country:US
Practice Address - Phone:620-363-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-06
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer