Healthcare Provider Details

I. General information

NPI: 1366704702
Provider Name (Legal Business Name): JOSHUA ALLEN YEAGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MEDICAL DR
CARMEL IN
46032-2923
US

IV. Provider business mailing address

118 MEDICAL DR
CARMEL IN
46032-2923
US

V. Phone/Fax

Practice location:
  • Phone: 317-573-1037
  • Fax:
Mailing address:
  • Phone: 317-573-1037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number99051809A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: