Provider Demographics
NPI:1396378147
Name:WANG, YAN MIN (MT)
Entity Type:Individual
Prefix:MS
First Name:YAN MIN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MT
Other - Prefix:MS
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT
Mailing Address - Street 1:10291 N MERIDIAN ST STE 170
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1000
Mailing Address - Country:US
Mailing Address - Phone:317-658-4987
Mailing Address - Fax:833-884-9394
Practice Address - Street 1:10291 N MERIDIAN ST STE 170
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1000
Practice Address - Country:US
Practice Address - Phone:317-658-4987
Practice Address - Fax:833-884-9394
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21605783172M00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist