Provider Demographics
NPI:1669830733
Name:YANEZ, HALLIE (DPT)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:YANEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:
Other - Last Name:FOURNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-541-3735
Practice Address - Street 1:1854 W AUBURN RD STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309
Practice Address - Country:US
Practice Address - Phone:248-243-3330
Practice Address - Fax:248-243-3331
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist