Individual
TAYLAR MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
8501 FM 407, DOUBLE OAK, TX 75077-3031
(972) 966-1980
Mailing address
408 W OLD PLANK RD APT 105, COLUMBIA, MO 65203-2078
(682) 622-9235
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
06/04/2017
Last updated
06/04/2017
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