Healthcare Provider Details

I. General information

NPI: 1932325545
Provider Name (Legal Business Name): MARIE CARMEN R YU P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4606 S CLYDE MORRIS BLVD SUITE 1-D
PORT ORANGE FL
32129-6404
US

IV. Provider business mailing address

PO BOX 290699
PORT ORANGE FL
32129-0699
US

V. Phone/Fax

Practice location:
  • Phone: 386-492-2986
  • Fax: 386-492-2987
Mailing address:
  • Phone: 386-256-8745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7269
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: