MEDICARE: HALEY YEACKLEY PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	1318	NE

General Provider Information

NPI Number	:	1043608961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY YEACKLEY PTA

Provider Business Mailing Address
First Line	:	810 6TH ST
Second Line	:
City	:	MILFORD
State	:	NE
Zip	:	68405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 6TH ST
Second Line	:
City	:	MILFORD
State	:	NE
Zip	:	68405-9300
Country	:	US
Telephone Number	:	402-641-4499
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2014
Last Update Date	:	12/30/2014

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Directions to “ HALEY YEACKLEY PTA” Practice Location

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