Healthcare Provider Details

I. General information

NPI: 1033497789
Provider Name (Legal Business Name): KATHRYN LOUISE YEAGER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MEIJER DR STE 104
FLORENCE KY
41042-4878
US

IV. Provider business mailing address

7567 CENTRAL PARKE BLVD
MASON OH
45040-6852
US

V. Phone/Fax

Practice location:
  • Phone: 859-538-1165
  • Fax: 859-538-1164
Mailing address:
  • Phone: 513-701-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004540
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: