Provider Demographics
NPI:1831305333
Name:JUNIOR YOGI
Entity Type:Organization
Organization Name:JUNIOR YOGI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:YOGA THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:586-764-0837
Mailing Address - Street 1:2269 BRIDLE TRL
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-9270
Mailing Address - Country:US
Mailing Address - Phone:586-764-0837
Mailing Address - Fax:810-724-8872
Practice Address - Street 1:2269 BRIDLE TRL
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-9270
Practice Address - Country:US
Practice Address - Phone:586-764-0837
Practice Address - Fax:810-724-8872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty