Provider Demographics
NPI:1578258299
Name:PAWLYSHYN, YOLANDA (PT)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:PAWLYSHYN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 LAKEMONT DR
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-2941
Mailing Address - Country:US
Mailing Address - Phone:239-537-9625
Mailing Address - Fax:
Practice Address - Street 1:3601 LAKEMONT DR
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-2941
Practice Address - Country:US
Practice Address - Phone:239-537-9625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist