Provider Demographics
NPI:1679092894
Name:YANYECIC, MARK (PTA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:YANYECIC
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10451 ANDOVER POINT CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-2734
Mailing Address - Country:US
Mailing Address - Phone:407-484-2495
Mailing Address - Fax:
Practice Address - Street 1:730 COURTLAND ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-1316
Practice Address - Country:US
Practice Address - Phone:407-484-2495
Practice Address - Fax:407-484-2495
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant