Basic Information
Provider Information
NPI: 1437825700
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YAITANES
FirstName: DAHNE
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: LEDFORD
OtherFirstName: DAHNE
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 73 NEWTON RD UNIT 101
Address2:  
City: PLAISTOW
State: NH
PostalCode: 038652440
CountryCode: US
TelephoneNumber: 9783887272
FaxNumber: 9783887373
Practice Location
Address1: 74 GRAY RD
Address2:  
City: FALMOUTH
State: ME
PostalCode: 041052062
CountryCode: US
TelephoneNumber: 2077973006
FaxNumber: 2077973002
Other Information
ProviderEnumerationDate: 08/18/2021
LastUpdateDate: 08/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/18/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT6036MEY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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