Provider Demographics
NPI:1609069210
Name:YENGO, LAURA CHRISTINE (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CHRISTINE
Last Name:YENGO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5704 E LAKE SAMMAMISH PKWY SE
Mailing Address - Street 2:STE. #101
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-8941
Mailing Address - Country:US
Mailing Address - Phone:425-270-3323
Mailing Address - Fax:425-270-3326
Practice Address - Street 1:5704 E LAKE SAMMAMISH PKWY SE
Practice Address - Street 2:STE. #101
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-8941
Practice Address - Country:US
Practice Address - Phone:425-270-3323
Practice Address - Fax:425-270-3326
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8896641Medicare PIN