MEDICARE: YEKATERINA YERMOLOVA

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	027383	PA

General Provider Information

NPI Number	:	1427528413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEKATERINA YERMOLOVA

Provider Business Mailing Address
First Line	:	301 SILVER OAK CT
Second Line	:
City	:	WARWICK
State	:	PA
Zip	:	18974-3851
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 WELSH RD
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-3771
Country	:	US
Telephone Number	:	215-361-3622
Fax Number	:

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

Provider Enumeration Date	:	12/03/2018
Last Update Date	:	12/03/2018

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Directions to “ YEKATERINA YERMOLOVA ” Practice Location

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