MEDICARE: LEAH YACOUB

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	225200000X	Physical Therapy Assistant	5502003135	MI

General Provider Information

NPI Number	:	1932508702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH YACOUB

Provider Business Mailing Address
First Line	:	21096 STRAWBERRY HILLS DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48044-2274
Country	:	US
Telephone Number	:	586-421-2205
Fax Number	:

Provider Business Practice Location Address
First Line	:	21096 STRAWBERRY HILLS DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48044-2274
Country	:	US
Telephone Number	:	586-421-2205
Fax Number	:

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

Provider Enumeration Date	:	08/18/2014
Last Update Date	:	08/18/2014

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Directions to “ LEAH YACOUB ” Practice Location

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