1285099390 NPI number — ASHLEY CARROLL YELMINI MAT, LAT, ATC

Table of content: ASHLEY CARROLL YELMINI MAT, LAT, ATC (NPI 1285099390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285099390 NPI number — ASHLEY CARROLL YELMINI MAT, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YELMINI
Provider First Name:
ASHLEY
Provider Middle Name:
CARROLL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MAT, LAT, ATC
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:
1285099390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 GALLENT HEDGE TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APEX
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27539-6506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-607-1171
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7801 HUMIE OLIVE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APEX
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27502-9627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-694-0500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2015

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: 2255A2300X , with the licence number:  2141 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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