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General NPI Number Information
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NPI Number | 1467885947
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Entity Type | Individual
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Provider Name | ELIZABETH NICOLE YAW PT
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Gender | Female
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 701 PLATINUM PT
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City | LAKE MARY
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State | FL
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Zip | 32746-4871
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Country | US
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Telephone | 407-246-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 336 BROAD ST # 203
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City | ROME
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State | GA
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Zip | 30161-3006
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Country | US
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Telephone | 386-851-0901
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Fax | 386-851-2426
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 28534
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License Number State | FL
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