Healthcare Provider Details

I. General information

NPI: 1134572084
Provider Name (Legal Business Name): JOHN RAYMOND YANDEK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 09/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15601 REDINGTON DR
REDINGTON BEACH FL
33708-1739
US

IV. Provider business mailing address

15601 REDINGTON DR
REDINGTON BEACH FL
33708-1739
US

V. Phone/Fax

Practice location:
  • Phone: 727-512-4316
  • Fax:
Mailing address:
  • Phone: 727-512-4316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA26802
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA003680
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: