Healthcare Provider Details

I. General information

NPI: 1720627953
Provider Name (Legal Business Name): CATHERINE LOUISE YEAGER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHERINE LOUISE MCQUAID LMT

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 BEACH 126TH ST
ROCKAWAY PARK NY
11694-1721
US

IV. Provider business mailing address

246 BEACH 126TH ST
ROCKAWAY PARK NY
11694-1721
US

V. Phone/Fax

Practice location:
  • Phone: 917-821-3555
  • Fax:
Mailing address:
  • Phone: 917-821-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number023013
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number023013
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: