MEDICARE: MR. MATTHEW DENHAM YGLESIAS P.T.

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	225100000X	Physical Therapist	06917	LA

General Provider Information

NPI Number	:	1487600383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW DENHAM YGLESIAS P.T.

Provider Business Mailing Address
First Line	:	1219 CHURCH ST
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791-2347
Country	:	US
Telephone Number	:	225-658-7751
Fax Number	:	225-658-7753

Provider Business Practice Location Address
First Line	:	7648 PICARDY AVE
Second Line	:	SUITE 300
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-4335
Country	:	US
Telephone Number	:	225-768-7676
Fax Number	:	225-768-7373

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	01/07/2013

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