Provider Demographics
NPI:1427537463
Name:KIL, YERI
Entity Type:Individual
Prefix:
First Name:YERI
Middle Name:
Last Name:KIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S 5TH AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-2753
Mailing Address - Country:US
Mailing Address - Phone:614-619-4342
Mailing Address - Fax:
Practice Address - Street 1:2720 E RIVER RD STE 6150
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6636
Practice Address - Country:US
Practice Address - Phone:520-420-1190
Practice Address - Fax:520-420-1191
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-30146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD10742001OtherDRIVER'S LICENSE
OHUH665490OtherDRIVER'S LICENSE