Healthcare Provider Details

I. General information

NPI: 1114550563
Provider Name (Legal Business Name): STEPHANIE YARDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 MURRELL RD
ROCKLEDGE FL
32955-4741
US

IV. Provider business mailing address

2077 DEERCROFT DR
VIERA FL
32940-6347
US

V. Phone/Fax

Practice location:
  • Phone: 321-339-9202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number29560
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: