Provider Demographics
NPI:1902386287
Name:YATES, THOMAS ROBERT (LMT, CMMP, CPMT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ROBERT
Last Name:YATES
Suffix:
Gender:M
Credentials:LMT, CMMP, CPMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 15TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-1921
Mailing Address - Country:US
Mailing Address - Phone:301-690-5671
Mailing Address - Fax:
Practice Address - Street 1:1517 15TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-1921
Practice Address - Country:US
Practice Address - Phone:301-690-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT1961225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist