Healthcare Provider Details

I. General information

NPI: 1194712489
Provider Name (Legal Business Name): BERNARD A YAUN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2005
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 ROXBURY RD
ROCKFORD IL
61107-5090
US

IV. Provider business mailing address

324 ROXBURY RD
ROCKFORD IL
61107-5090
US

V. Phone/Fax

Practice location:
  • Phone: 815-398-9491
  • Fax: 815-381-7498
Mailing address:
  • Phone: 815-398-9491
  • Fax: 815-381-7498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070010859
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: