Provider Demographics
NPI:1790361103
Name:YE, MANDY (DPT)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:YE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 ROBERT TRENT JONES LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3046
Mailing Address - Country:US
Mailing Address - Phone:347-827-8411
Mailing Address - Fax:
Practice Address - Street 1:2904 W HORIZON RIDGE PKWY STE 121
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5016
Practice Address - Country:US
Practice Address - Phone:702-897-7331
Practice Address - Fax:702-897-6801
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4826225100000X
NY047042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty