Provider Demographics
NPI:1164830717
Name:YAKUBOV, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:YAKUBOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:KOROTKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:706 RAIKES RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3418
Mailing Address - Country:US
Mailing Address - Phone:215-292-1330
Mailing Address - Fax:
Practice Address - Street 1:706 RAIKES RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-3418
Practice Address - Country:US
Practice Address - Phone:215-292-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist