Healthcare Provider Details

I. General information

NPI: 1639595085
Provider Name (Legal Business Name): YELM PHYSICAL THERAPY SERVICES INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W YELM AVE
YELM WA
98597-7679
US

IV. Provider business mailing address

100 DENNIS ST SW STE B
TUMWATER WA
98501-6523
US

V. Phone/Fax

Practice location:
  • Phone: 360-458-2444
  • Fax: 360-458-2747
Mailing address:
  • Phone: 360-458-2444
  • Fax: 360-458-2747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY A PROVOZNIK
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 360-338-0181