MEDICARE: MRS. NICOLE CHRISTINE YARE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	23316	MD

General Provider Information

NPI Number	:	1316284870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE CHRISTINE YARE DPT

Provider Business Mailing Address
First Line	:	1047 CEDAR RIDGE CT
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21403-1924
Country	:	US
Telephone Number	:	301-404-4189
Fax Number	:

Provider Business Practice Location Address
First Line	:	16900 SCIENCE DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20715-4401
Country	:	US
Telephone Number	:	301-805-7110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	01/03/2013

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