Active NPI
Mark Benjamin Taylor, P.T.
- Physical Therapist
- Antioch, CA
National Provider Identifier
1013070549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT16211
- Practice address
- 2213 Buchanan Rd
Suite 210
Antioch, CA 94509-4265 - Phone
- (925) 779-2592
- Fax
- (925) 779-2521
- NPI assigned
- Dec 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT16211 | CA | Primary |
Addresses
Primary practice location
2213 Buchanan Rd
Suite 210
Antioch, CA 94509-4265
Mailing address
174 E Seaview Dr
Benicia, CA 94510-2152
Phone (707) 746-1397
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT16211 | CA | MD | Physical Therapist |
| 16211 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013070549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "174 E SEAVIEW DR",
"city": "BENICIA",
"state": "CA",
"postal_code": "945102152",
"telephone_number": "707-746-1397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2213 BUCHANAN RD",
"address_2": "SUITE 210",
"city": "ANTIOCH",
"state": "CA",
"postal_code": "945094265",
"telephone_number": "925-779-2592",
"fax_number": "925-779-2521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAYLOR",
"first_name": "MARK",
"middle_name": "BENJAMIN",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT16211",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Antioch, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.