Provider Demographics
NPI:1659849255
Name:YEBRA, TOMAS RANGEL (DPT)
Entity Type:Individual
Prefix:MR
First Name:TOMAS
Middle Name:RANGEL
Last Name:YEBRA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:MR
Other - First Name:TOMAS
Other - Middle Name:
Other - Last Name:RANGEL-YEBRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:BELLE HAVEN
Mailing Address - State:VA
Mailing Address - Zip Code:23306-0149
Mailing Address - Country:US
Mailing Address - Phone:757-442-5222
Mailing Address - Fax:757-442-6333
Practice Address - Street 1:15405 MERRY CAT LANE
Practice Address - Street 2:
Practice Address - City:BELLE HAVEN
Practice Address - State:VA
Practice Address - Zip Code:23306
Practice Address - Country:US
Practice Address - Phone:757-442-5222
Practice Address - Fax:757-442-6333
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist