Basic Information
| Provider Information | |||||||||
| NPI: | 1356867428 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAVROMMATAKIS | ||||||||
| FirstName: | YANNIS | ||||||||
| MiddleName: | EMMANUEL | ||||||||
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| Credential: | DPT, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2506 281ST AVE NE | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980533119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9173328437 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 110TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980045828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256282072 | ||||||||
| FaxNumber: | 4256282072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2017 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 041916 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT61160514 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.