1215003769 NPI number — MS. REBECCA ANN YURKO MPT

Table of content: MS. REBECCA ANN YURKO MPT (NPI 1215003769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215003769 NPI number — MS. REBECCA ANN YURKO MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YURKO
Provider First Name:
REBECCA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215003769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 MAIN ST
Provider Second Line Business Mailing Address:
GEM-RIVERSIDE REHAB
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18612-1604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-674-2659
Provider Business Mailing Address Fax Number:
570-675-8980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 MAIN ST
Provider Second Line Business Practice Location Address:
GEM-RIVERSIDE REHAB
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18612-1604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-674-2659
Provider Business Practice Location Address Fax Number:
570-675-8980
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT011699L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1523082 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 445265 . This is a "HEALTH AMERICA ASSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 352331 . This is a "HEALTH AMERICA ASSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 815884 . This is a "FIRST PRIORITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 442566 . This is a "HEALTH AMERICA ASSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 818046 . This is a "FIRST PRIORITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 818045 . This is a "FIRST PRIORITY" identifier . This identifiers is of the category "OTHER".




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