MEDICARE: MR. RICHARD JAY YAMIN PTA,, ATC

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	PTA 3738	TN

General Provider Information

NPI Number	:	1427072024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD JAY YAMIN PTA,, ATC

Provider Business Mailing Address
First Line	:	104 GLEN OAK BLVD
Second Line	:	SUITE 120
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-6423
Country	:	US
Telephone Number	:	615-338-4391
Fax Number	:	615-338-4304

Provider Business Practice Location Address
First Line	:	104 GLEN OAK BLVD
Second Line	:	SUITE 180
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-6423
Country	:	US
Telephone Number	:	615-338-4391
Fax Number	:	615-338-4304

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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