Healthcare Provider Details

I. General information

NPI: 1467315879
Provider Name (Legal Business Name): LAURA YURCHAK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W THOMAS RD STE 100
PHOENIX AZ
85013-4420
US

IV. Provider business mailing address

897 E ROMA AVE UNIT 3
PHOENIX AZ
85014-4162
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-1600
  • Fax:
Mailing address:
  • Phone: 517-897-5596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberLPT-034468
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: