Healthcare Provider Details

I. General information

NPI: 1134370471
Provider Name (Legal Business Name): TRACIE ELIZABETH YEAMAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN ST WACC 134
BOSTON MA
02114-3117
US

IV. Provider business mailing address

15 PARKMAN ST WACC 134
BOSTON MA
02114-3117
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-0125
  • Fax: 617-726-2957
Mailing address:
  • Phone: 617-724-0125
  • Fax: 617-726-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18205
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: