Individual
TAYLOR J. WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS,LAT, ATC
Contact information
Practice address
8600 E ROCKCLIFF RD, TUCSON, AZ 85750-9733
(520) 749-9655
Mailing address
5441 N SWAN RD, APT 625, TUCSON, AZ 85718-5434
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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