1033497789 NPI number — KATHRYN LOUISE YEAGER DPT

Table of content: KATHRYN LOUISE YEAGER DPT (NPI 1033497789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033497789 NPI number — KATHRYN LOUISE YEAGER DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YEAGER
Provider First Name:
KATHRYN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1033497789
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7567 CENTRAL PARKE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45040-6852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-701-6100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MEIJER DR STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41042-4878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-538-1165
Provider Business Practice Location Address Fax Number:
859-538-1164
Provider Enumeration Date:
07/29/2011

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:  004540 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P01467616 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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