Provider Demographics
NPI:1508562943
Name:YATES, JOHNNYE J (LMT)
Entity Type:Individual
Prefix:
First Name:JOHNNYE
Middle Name:J
Last Name:YATES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SPINNAKER RIDGE DR SW APT C112
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35824-1315
Mailing Address - Country:US
Mailing Address - Phone:318-218-5634
Mailing Address - Fax:
Practice Address - Street 1:130 SPINNAKER RIDGE DR SW APT C112
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35824-1315
Practice Address - Country:US
Practice Address - Phone:318-218-5634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5398225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5398OtherMASSAGE THERAPIST