Healthcare Provider Details

I. General information

NPI: 1588394332
Provider Name (Legal Business Name): MICHAEL YIP PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N ALTADENA DR STE 100
PASADENA CA
91107-3369
US

IV. Provider business mailing address

8124 BLEWETT ST
ROSEMEAD CA
91770-3931
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-0523
  • Fax:
Mailing address:
  • Phone: 626-475-9308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number301293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: