Healthcare Provider Details

I. General information

NPI: 1790872315
Provider Name (Legal Business Name): RENEE M YACKEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E WILLOW AVE STE 110
WHEATON IL
60187-5529
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-469-9200
  • Fax: 630-653-3581
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070007365
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: