Provider Demographics
NPI:1194004010
Name:YATES, STEVEN KIP (LMT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:KIP
Last Name:YATES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:KIP
Other - Middle Name:
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:609 MYRTLE AVE
Mailing Address - Street 2:2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1469
Mailing Address - Country:US
Mailing Address - Phone:646-552-7526
Mailing Address - Fax:
Practice Address - Street 1:609 MYRTLE AVE
Practice Address - Street 2:2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-1469
Practice Address - Country:US
Practice Address - Phone:646-552-7526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025014225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist