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General NPI Number Information
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NPI Number | 1740463991
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Entity Type | Individual
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Provider Name | KIM MICHELLE YEAROUT L.P.T.
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Gender | Female
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 9727 SHANNON WOODS
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City | WICHITA
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State | KS
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Zip | 67226-4102
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Country | US
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Telephone | 316-219-0253
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Fax | 316-219-0254
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Provider Business Mailing Address
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Address Line | 9727 SHANNON WOODS
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City | WICHITA
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State | KS
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Zip | 67226-4102
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Country | US
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Telephone | 316-219-0253
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Fax | 316-219-0254
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 11-01000
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License Number State | KS
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