Provider Demographics
NPI:1073931382
Name:YEAROUT, MISTIE LINN
Entity Type:Individual
Prefix:MRS
First Name:MISTIE
Middle Name:LINN
Last Name:YEAROUT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MISTIE
Other - Middle Name:LINN
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:15292 S WYANDOTTE DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-7001
Mailing Address - Country:US
Mailing Address - Phone:913-390-7004
Mailing Address - Fax:
Practice Address - Street 1:11970 S BLACKBOB RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-2022
Practice Address - Country:US
Practice Address - Phone:913-393-0992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02806225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist