Healthcare Provider Details

I. General information

NPI: 1841865961
Provider Name (Legal Business Name): EDWARD G YACYNYCH PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 HILLHURST AVE FL 1
LOS ANGELES CA
90027-2711
US

IV. Provider business mailing address

2227 EFFIE STREET
LOS ANGELES CA
90026
US

V. Phone/Fax

Practice location:
  • Phone: 323-912-9166
  • Fax:
Mailing address:
  • Phone: 410-206-7572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number297030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: