Provider Demographics
NPI:1316581036
Name:YERDON, DANICA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:DANICA
Middle Name:MARIE
Last Name:YERDON
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 1:3305 VIEW RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-1526
Mailing Address - Country:US
Mailing Address - Phone:443-789-9640
Mailing Address - Fax:
Practice Address - Street 1:3332 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-1952
Practice Address - Country:US
Practice Address - Phone:410-239-7139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD192896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist