Healthcare Provider Details

I. General information

NPI: 1134459704
Provider Name (Legal Business Name): YEAGER PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 DOWDELL LN
SAINT HELENA CA
94574-1452
US

IV. Provider business mailing address

PO BOX 74
ANGWIN CA
94508-0074
US

V. Phone/Fax

Practice location:
  • Phone: 707-967-0510
  • Fax: 707-967-0515
Mailing address:
  • Phone: 707-965-9828
  • Fax: 707-967-0515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT14117
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL YEAGER
Title or Position: PRESIDENT
Credential: PT
Phone: 707-260-5164