Provider Demographics
NPI:1437879368
Name:YADAO, PAUL REGINALD MATEO (DPT)
Entity Type:Individual
Prefix:
First Name:PAUL REGINALD
Middle Name:MATEO
Last Name:YADAO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:951-335-9825
Mailing Address - Fax:812-590-8333
Practice Address - Street 1:8215 ROCHESTER AVE STE 110
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0727
Practice Address - Country:US
Practice Address - Phone:909-892-3020
Practice Address - Fax:909-892-3021
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA302905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist