Individual ProviderJackson TaylorPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address863 N Main Street Ext Ste 200, Wallingford, CT 06492-2434(203) 265-3280PECOS EnrollmentBased on the most recent information from CMS, provider Jackson Taylor does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1881251585Provider TypeIndividualFull NameTaylor, JacksonGenderMaleSole ProprietorYesEnumeration Date5/29/2019Last Updated5/29/2019Contact InformationPractice LocationPractice Address863 N Main Street Ext Ste 200, Wallingford, CT 06492-2434Phone(203) 265-3280FaxUnlisted FaxMailing LocationMailing Address655 S Willow St Ste 128, Manchester, NH 03103-5705PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense12178ConnecticutCode225100000XDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense24093Massachusetts