Provider Demographics
NPI:1174686067
Name:YURKO, LOUISE DIBENEDETTO (PT)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:DIBENEDETTO
Last Name:YURKO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-8119
Mailing Address - Country:US
Mailing Address - Phone:252-726-2485
Mailing Address - Fax:252-726-2485
Practice Address - Street 1:123 BUENA VISTA DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-8119
Practice Address - Country:US
Practice Address - Phone:252-726-2485
Practice Address - Fax:252-726-2485
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07773OtherBCBS PROVIDER NUMBER
NC20025Medicare PIN