Provider Demographics
NPI:1134459704
Name:YEAGER PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:YEAGER PHYSICAL THERAPY, INC.
Other - Org Name:MACS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YEAGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:707-260-5164
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:ANGWIN
Mailing Address - State:CA
Mailing Address - Zip Code:94508-0074
Mailing Address - Country:US
Mailing Address - Phone:707-965-9828
Mailing Address - Fax:707-967-0515
Practice Address - Street 1:930 DOWDELL LN
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-1452
Practice Address - Country:US
Practice Address - Phone:707-967-0510
Practice Address - Fax:707-967-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty