Healthcare Provider Details

I. General information

NPI: 1174763114
Provider Name (Legal Business Name): ANNA JEAN YAVORCIK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 OLENTANGY RIVER RD STE 260
COLUMBUS OH
43214-3467
US

IV. Provider business mailing address

5350 FRANTZ RD
DUBLIN OH
43016-4259
US

V. Phone/Fax

Practice location:
  • Phone: 614-586-1220
  • Fax: 614-586-1237
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-001601
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: