Provider Demographics
NPI:1629103403
Name:YANNI, BRIDGET A (CMT)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:A
Last Name:YANNI
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 N KESWICK AVE
Mailing Address - Street 2:STORE FRONT
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4823
Mailing Address - Country:US
Mailing Address - Phone:215-572-9881
Mailing Address - Fax:215-572-9892
Practice Address - Street 1:276 N KESWICK AVE
Practice Address - Street 2:STORE FRONT
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4823
Practice Address - Country:US
Practice Address - Phone:215-572-9881
Practice Address - Fax:215-572-9892
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA83010646225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist