Healthcare Provider Details

I. General information

NPI: 1649229725
Provider Name (Legal Business Name): TIMOTHY LOGAN YOST P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PROFESSIONAL LANE SUITE 102
HARLAN KY
40831
US

IV. Provider business mailing address

383 CORBIN CENTER DRIVE
CORBIN KY
40701
US

V. Phone/Fax

Practice location:
  • Phone: 606-573-9539
  • Fax: 606-573-7390
Mailing address:
  • Phone: 606-526-2900
  • Fax: 606-526-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004012
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: