Provider Demographics
NPI:1417604406
Name:YOST, LEA D (PT)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:D
Last Name:YOST
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 1:5255 SE STARGRASS ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-8529
Mailing Address - Country:US
Mailing Address - Phone:360-348-0111
Mailing Address - Fax:
Practice Address - Street 1:7515 NE AMBASSADOR PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-1379
Practice Address - Country:US
Practice Address - Phone:503-261-8599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009924225100000X
ORPT62455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist