Healthcare Provider Details

I. General information

NPI: 1316581036
Provider Name (Legal Business Name): DANICA MARIE YERDON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 MAIN ST
MANCHESTER MD
21102-1952
US

IV. Provider business mailing address

3305 VIEW RIDGE CT
MANCHESTER MD
21102-1526
US

V. Phone/Fax

Practice location:
  • Phone: 410-239-7139
  • Fax:
Mailing address:
  • Phone: 443-789-9640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number192896
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: