Provider Demographics
NPI:1528371945
Name:YANNACE, MICHAELA (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:YANNACE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 SPRINGHURST DR
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-2261
Mailing Address - Country:US
Mailing Address - Phone:518-479-7172
Mailing Address - Fax:518-286-3798
Practice Address - Street 1:3 SPRINGHURST DR
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2261
Practice Address - Country:US
Practice Address - Phone:518-479-7172
Practice Address - Fax:518-286-3798
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032773-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist