Individual
JACOB ALEXANDER TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3972 CHESTNUT GROVE RD, SWANTON, MD 21561-1437
(301) 707-7702
Mailing address
3972 CHESTNUT GROVE RD, SWANTON, MD 21561-1437
(301) 707-7702
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A5114
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HUF3HZN60814420
BLUE CROSS BLUE SHIELD
MD
Enumeration date
01/22/2019
Last updated
01/22/2019
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