Taylor John Vissers

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA28773 Issued in FL

Practice address

48 Osprey Village Dr
Fernandina, FL 32034-4955

Phone

(904) 277-8222

NPI assigned

Dec 20, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545264000000",
    "number": "1083186589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55246 LITTLE BROOK DR",
            "city": "CALLAHAN",
            "state": "FL",
            "postal_code": "320115595",
            "telephone_number": "904-629-9678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 OSPREY VILLAGE DR",
            "city": "FERNANDINA",
            "state": "FL",
            "postal_code": "320344955",
            "telephone_number": "904-277-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VISSERS",
        "first_name": "TAYLOR",
        "middle_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-20",
        "last_updated": "2018-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA28773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Professional Dental Alliance of Fernandina Beach, PLLC
• Tia Briana Raysor, PHARMD
• Russell Stackhouse MD PA
• Robert Harvey Springer III, P.T.A.
• James Russell Keller Stackhouse, MD

• Physical Therapy Assistant in Fernandina, FL
• Providers in Fernandina, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.