Healthcare Provider Details

I. General information

NPI: 1710562418
Provider Name (Legal Business Name): TAYLOR YEZEK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2021
Last Update Date: 03/14/2021
Certification Date: 03/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 N E ST
INDIANOLA IA
50125-3276
US

IV. Provider business mailing address

504 10TH CT SE
BONDURANT IA
50035-2048
US

V. Phone/Fax

Practice location:
  • Phone: 515-961-7458
  • Fax:
Mailing address:
  • Phone: 641-420-6747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number095800
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: