Healthcare Provider Details

I. General information

NPI: 1366778334
Provider Name (Legal Business Name): TOMI L. YACKER BSN, NCTMB, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38775 N GILBERT AVE
BEACH PARK IL
60099-3859
US

IV. Provider business mailing address

38775 N GILBERT AVE
BEACH PARK IL
60099-3859
US

V. Phone/Fax

Practice location:
  • Phone: 224-374-7808
  • Fax: 847-623-7837
Mailing address:
  • Phone: 224-374-7808
  • Fax: 847-623-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number227.009648
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: