Healthcare Provider Details

I. General information

NPI: 1770099517
Provider Name (Legal Business Name): CHANTEL NICOLE YEARWOOD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 ASHLEY OAKS CIR
WESLEY CHAPEL FL
33544-6400
US

IV. Provider business mailing address

613 S MAGNOLIA AVE
TAMPA FL
33606-2767
US

V. Phone/Fax

Practice location:
  • Phone: 813-907-0430
  • Fax: 813-907-0963
Mailing address:
  • Phone: 813-254-9475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT32935
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: