Provider Demographics
NPI:1508977331
Name:YENOR, EMILY DODDS (MPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:DODDS
Last Name:YENOR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10245 W SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2348
Mailing Address - Country:US
Mailing Address - Phone:414-405-3956
Mailing Address - Fax:
Practice Address - Street 1:13825 W BURLEIGH RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3058
Practice Address - Country:US
Practice Address - Phone:262-754-3450
Practice Address - Fax:262-754-3450
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9498024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI834240007Medicare ID - Type Unspecified