Healthcare Provider Details

I. General information

NPI: 1043608961
Provider Name (Legal Business Name): HALEY YEACKLEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 6TH ST
MILFORD NE
68405-9300
US

IV. Provider business mailing address

810 6TH ST
MILFORD NE
68405
US

V. Phone/Fax

Practice location:
  • Phone: 402-641-4499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1318
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: