MEDICARE: MRS. CARRIE J YERKEY LPTA

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	001166	WV

General Provider Information

NPI Number	:	1134248669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARRIE J YERKEY LPTA

Provider Business Mailing Address
First Line	:	89F CHUB RUN RD
Second Line	:
City	:	MOUNT CLARE
State	:	WV
Zip	:	26408-9501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	89F CHUB RUN RD
Second Line	:
City	:	MOUNT CLARE
State	:	WV
Zip	:	26408-9501
Country	:	US
Telephone Number	:	304-624-4687
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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