Provider Demographics
NPI:1356867428
Name:MAVROMMATAKIS, YANNIS EMMANUEL (DPT, PHD)
Entity Type:Individual
Prefix:
First Name:YANNIS
Middle Name:EMMANUEL
Last Name:MAVROMMATAKIS
Suffix:
Gender:M
Credentials:DPT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 281ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-3119
Mailing Address - Country:US
Mailing Address - Phone:917-332-8437
Mailing Address - Fax:
Practice Address - Street 1:110 110TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5828
Practice Address - Country:US
Practice Address - Phone:425-628-2072
Practice Address - Fax:425-628-2072
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041916225100000X
WAPT61160514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist