Basic Information
| Provider Information | |||||||||
| NPI: | 1316581036 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YERDON | ||||||||
| FirstName: | DANICA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3305 VIEW RIDGE CT | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211021526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437899640 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3332 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211021952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102397139 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2019 | ||||||||
| LastUpdateDate: | 11/06/2019 | ||||||||
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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 | 192896 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.