Basic Information
| Provider Information | |||||||||
| NPI: | 1669737151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YANDZIAK | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 534 N 35TH ST STE D | ||||||||
| Address2: | |||||||||
| City: | MOREHEAD CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285573184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527261802 | ||||||||
| FaxNumber: | 2527261805 | ||||||||
| Practice Location | |||||||||
| Address1: | 534 N 35TH ST STE D | ||||||||
| Address2: | |||||||||
| City: | MOREHEAD CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285573184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527261802 | ||||||||
| FaxNumber: | 2527261805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2012 | ||||||||
| LastUpdateDate: | 11/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | GA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | P18521 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.