Healthcare Provider Details

I. General information

NPI: 1689884710
Provider Name (Legal Business Name): LYNNE M YAVERSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOCES DR
YORKTOWN HEIGHTS NY
10598-4321
US

IV. Provider business mailing address

46 COTTAGE ST
MONROE CT
06468-2917
US

V. Phone/Fax

Practice location:
  • Phone: 914-248-2250
  • Fax:
Mailing address:
  • Phone: 203-445-0142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number003977-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: