Provider Demographics
NPI:1871870766
Name:MASTEN, TAYLOR NEIL (ATC)
Entity type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:NEIL
Last Name:MASTEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 E SIERRA AVE
Mailing Address - Street 2:#117
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-3604
Mailing Address - Country:US
Mailing Address - Phone:831-869-9946
Mailing Address - Fax:
Practice Address - Street 1:5150 N MAPLE AVE
Practice Address - Street 2:M/S JA 71
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93740-0001
Practice Address - Country:US
Practice Address - Phone:559-278-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer