Healthcare Provider Details

I. General information

NPI: 1316869704
Provider Name (Legal Business Name): KATHERYN YATES PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 CHEVERLY AVE
CHEVERLY MD
20785-3009
US

IV. Provider business mailing address

2209 CHEVERLY AVE
CHEVERLY MD
20785-3009
US

V. Phone/Fax

Practice location:
  • Phone: 240-604-6698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA6227
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: