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MR. JOHN RICHARD TAYLOR III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
2813 FOREST AVE, GRANITE CITY, IL 62040-6025
(618) 670-8584
Mailing address
2813 FOREST AVE, GRANITE CITY, IL 62040-6025
(618) 670-8584

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
160005050
IL
225200000X
Physical Therapy Assistant
Primary
2010041285
MO

Other

Enumeration date
06/06/2012
Last updated
06/06/2012
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