Provider Demographics
NPI:1033640081
Name:YOST, JENINE SWAN (DPT)
Entity Type:Individual
Prefix:
First Name:JENINE
Middle Name:SWAN
Last Name:YOST
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5324 OAKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-2332
Mailing Address - Country:US
Mailing Address - Phone:909-754-1889
Mailing Address - Fax:
Practice Address - Street 1:5324 OAKVIEW LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-2332
Practice Address - Country:US
Practice Address - Phone:909-754-1889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist