Provider Demographics
NPI:1598836710
Name:YEAGER, PETER (MSPT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:YEAGER
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 E MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2955
Mailing Address - Country:US
Mailing Address - Phone:631-470-9515
Mailing Address - Fax:631-470-9513
Practice Address - Street 1:164 E MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2955
Practice Address - Country:US
Practice Address - Phone:631-470-9515
Practice Address - Fax:631-470-9513
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP7121Medicare UPIN