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General NPI Number Information
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NPI Number | 1609835297
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Entity Type | Individual
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Provider Name | YVONNE MARIE IVANOV RPT
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Gender | Female
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 209 W CENTRAL ST STE 313
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City | NATICK
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State | MA
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Zip | 01760-3765
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Country | US
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Telephone | 800-834-3997
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Fax |
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Provider Business Mailing Address
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Address Line | 47 OAKHURST RD
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City | HOPKINTON
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State | MA
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Zip | 01748-2721
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Country | US
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Telephone | 508-254-9162
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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 | 8215
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License Number State | MA
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