MEDICARE: CHARLOTTE YOUREE

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	2009171	TX

General Provider Information

NPI Number	:	1427345842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE YOUREE

Provider Business Mailing Address
First Line	:	PO BOX 9101
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-9494
Country	:	US
Telephone Number	:	972-745-7500
Fax Number	:	972-745-4376

Provider Business Practice Location Address
First Line	:	5000 WESTERN CENTER BLVD STE 220
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-2197
Country	:	US
Telephone Number	:	972-514-0519
Fax Number	:	817-514-8861

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

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	07/06/2011

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Directions to “ CHARLOTTE YOUREE ” Practice Location

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