Healthcare Provider Details

I. General information

NPI: 1962621854
Provider Name (Legal Business Name): ARIEL YABUT APARENTADO RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N BOWMAN AVENUE RD
DANVILLE IL
61832-2200
US

IV. Provider business mailing address

214 W 5TH ST SUITES D & E
JOPLIN MO
64801-2501
US

V. Phone/Fax

Practice location:
  • Phone: 217-443-2955
  • Fax:
Mailing address:
  • Phone: 417-827-8069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number2006022059
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: