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General NPI Number Information
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NPI Number | 1548770696
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Entity Type | Individual
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Provider Name | VANESSA YATES
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Gender | Female
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Dates
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Enumeration Date | 10/03/2017
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Last Update Date | 03/14/2023
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Provider Practice Location Address
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Address Line | 6530 VERSAILLES RD
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City | LAKE VIEW
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State | NY
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Zip | 14085-9666
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Country | US
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Telephone | 716-523-2602
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Fax |
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Provider Business Mailing Address
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Address Line | 6530 VERSAILLES RD
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City | LAKE VIEW
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State | NY
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Zip | 14085-9666
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Country | US
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Telephone |
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Fax |
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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 | 040.0128456
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 032277-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4991
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License Number State | NH
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT4844
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License Number State | ME
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