Healthcare Provider Details

I. General information

NPI: 1770898470
Provider Name (Legal Business Name): TAMRA LYNNE YAGLE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5006 LAKEVIEW DR
FLOYDS KNOBS IN
47119-9350
US

IV. Provider business mailing address

5006 LAKE VIEW DR
FLOYDS KNOBS IN
47119-9350
US

V. Phone/Fax

Practice location:
  • Phone: 502-419-4318
  • Fax:
Mailing address:
  • Phone: 502-419-4318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06000783A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: