Healthcare Provider Details

I. General information

NPI: 1568004687
Provider Name (Legal Business Name): JEREMY ADAM YEE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9479 SIDESADDLE DR
WILTON CA
95693-9241
US

IV. Provider business mailing address

9479 SIDESADDLE DR
WILTON CA
95693-9241
US

V. Phone/Fax

Practice location:
  • Phone: 916-716-3951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number297165
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: