MEDICARE: MS. CODY YELTON

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	225700000X	Massage Therapist	MA 62170	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA 62170	OTHER	FL	FL DEPT OF HEALTH

General Provider Information

NPI Number	:	1255620977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CODY YELTON

Provider Business Mailing Address
First Line	:	1421 NE 20TH AVE
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32609-3868
Country	:	US
Telephone Number	:	352-443-4217
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 NE 1ST ST
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32601-5311
Country	:	US
Telephone Number	:	352-443-4217
Fax Number	:

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

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	09/20/2016

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Directions to “ MS. CODY YELTON ” Practice Location

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