Provider Demographics
NPI:1710213582
Name:YEAKLEY, LANETTE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:LANETTE
Middle Name:MARIE
Last Name:YEAKLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 EL PASO BLVD
Mailing Address - Street 2:
Mailing Address - City:MANITOU SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80829-2310
Mailing Address - Country:US
Mailing Address - Phone:719-434-7415
Mailing Address - Fax:
Practice Address - Street 1:412 EL PASO BLVD
Practice Address - Street 2:
Practice Address - City:MANITOU SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80829-2310
Practice Address - Country:US
Practice Address - Phone:719-434-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99122251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics