Provider Demographics
NPI:1780186015
Name:YACKEL-FRIEND, KRISTIN KELLY (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:KELLY
Last Name:YACKEL-FRIEND
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 1:9495 SCHOMAKER RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-9675
Mailing Address - Country:US
Mailing Address - Phone:989-245-6446
Mailing Address - Fax:989-791-1147
Practice Address - Street 1:5810 GRATIOT RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-6063
Practice Address - Country:US
Practice Address - Phone:989-791-3771
Practice Address - Fax:989-791-1147
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist