MEDICARE: PORT CITY THERAPY, PLLC

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1679424741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT CITY THERAPY, PLLC

Provider Business Mailing Address
First Line	:	1010 MANDEVILLA CT E
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-4889
Country	:	US
Telephone Number	:	803-319-0592
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 MANDEVILLA CT E
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-4889
Country	:	US
Telephone Number	:	803-319-0592
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER LAUREN COLWELL YINGER
Credential	:	M.S., CCC-SLP
Telephone Number	:	803-319-0592

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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Directions to “PORT CITY THERAPY, PLLC ” Practice Location

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