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Individual
TAYLOR J. WADE
Active
Individual
TAYLOR J. WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS,LAT, ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1517
AZ
390200000X
Student in an Organized Health Care Education/Training Program
RT005978
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1517
ARIZONA BOARD OF ATHLETIC TRAINING
AZ
01
—
RT005978
PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS
PA
Enumeration date
03/31/2016
Last updated
12/24/2016
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