Provider Demographics
NPI:1194019745
Name:MARIE, YOLANDA (DPT, OMPT)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:MARIE
Suffix:
Gender:F
Credentials:DPT, OMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 KIMBERLEY RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6451
Mailing Address - Country:US
Mailing Address - Phone:586-596-6074
Mailing Address - Fax:
Practice Address - Street 1:2552 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3014
Practice Address - Country:US
Practice Address - Phone:313-278-7800
Practice Address - Fax:313-730-9880
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist