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NPI Code Detail

MEDICARE: LANETTE MARIE YEAKLEY PT

MEDICARE:   LANETTE MARIE YEAKLEY  PT
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
12251P0200XPediatric Physical Therapist9912CO

General Provider Information

NPI Number : 1710213582
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANETTE MARIE YEAKLEY PT
Provider Business Mailing Address
First Line : 412 EL PASO BLVD
Second Line :
City : MANITOU SPRINGS
State : CO
Zip : 80829-2310
Country : US
Telephone Number : 719-434-7415
Fax Number :
Provider Business Practice Location Address
First Line : 412 EL PASO BLVD
Second Line :
City : MANITOU SPRINGS
State : CO
Zip : 80829-2310
Country : US
Telephone Number : 719-434-7415
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2009
Last Update Date : 10/28/2009

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Directions to “ LANETTE MARIE YEAKLEY PT” Practice Location

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