Provider Demographics
NPI:1043608961
Name:YEACKLEY, HALEY (PTA)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:YEACKLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NE
Mailing Address - Zip Code:68405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:810 6TH ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NE
Practice Address - Zip Code:68405-9300
Practice Address - Country:US
Practice Address - Phone:402-641-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1318225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant