Healthcare Provider Details

I. General information

NPI: 1568584464
Provider Name (Legal Business Name): JENNIFER AMY YEAGER AASPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

3891 CHARLESTOWN RD
NEW ALBANY IN
47150-9562
US

IV. Provider business mailing address

535 SPICKERT KNOB RD
NEW ALBANY IN
47150-4247
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-3440
  • Fax: 812-945-3505
Mailing address:
  • Phone: 812-945-7663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002415A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: