Basic Information
| Provider Information | |||||||||
| NPI: | 1174605406 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SARDILLO | ||||||||
| FirstName: | YVETTE | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17270 BEAR VALLEY RD | ||||||||
| Address2: | STE 105 | ||||||||
| City: | VICTORVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923957751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602458828 | ||||||||
| FaxNumber: | 8558919996 | ||||||||
| Practice Location | |||||||||
| Address1: | 17270 BEAR VALLEY RD | ||||||||
| Address2: | STE 105 | ||||||||
| City: | VICTORVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923957751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602458828 | ||||||||
| FaxNumber: | 8558919996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 08/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT18956 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | P00279476 | 01 | CA | RAILROAD MC | OTHER | PT0189560 | 05 | CA | MEDICAID |