Organization
TAYLORED SHOES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH TAYLOR (OWNER/C.PED)
(707) 290-0627
Entity
Organization
Contact information
Practice address
1025 5TH ST, NOVATO, CA 94945-2413
(707) 290-0627
Mailing address
2401 WATERMAN BLVD, STE 4A, FAIRFIELD, CA 94534-1800
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
12/23/2011
Last updated
02/16/2012
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