Provider Demographics
NPI:1205034451
Name:DEPASS, PETA-GAY YANEKE (DPT)
Entity Type:Individual
Prefix:MISS
First Name:PETA-GAY
Middle Name:YANEKE
Last Name:DEPASS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 E 89TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1417
Mailing Address - Country:US
Mailing Address - Phone:561-508-5660
Mailing Address - Fax:
Practice Address - Street 1:249 E 89TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-1417
Practice Address - Country:US
Practice Address - Phone:561-508-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62026413225100000X
FL25437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist