Provider Demographics
NPI:1245415223
Name:YEARWOOD, CHISA (LPT)
Entity Type:Individual
Prefix:
First Name:CHISA
Middle Name:
Last Name:YEARWOOD
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 LEARY LN
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2818
Mailing Address - Country:US
Mailing Address - Phone:361-573-0731
Mailing Address - Fax:361-576-4804
Practice Address - Street 1:1905 LEARY LN
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2818
Practice Address - Country:US
Practice Address - Phone:361-573-0731
Practice Address - Fax:361-576-4804
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist