Provider Demographics
NPI:1912373820
Name:YEATTS, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:YEATTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8650 SOUTHWESTERN BLVD
Mailing Address - Street 2:#2612
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-2611
Mailing Address - Country:US
Mailing Address - Phone:940-367-7095
Mailing Address - Fax:
Practice Address - Street 1:6243 RETAIL RD
Practice Address - Street 2:SUITE 600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7808
Practice Address - Country:US
Practice Address - Phone:214-890-9853
Practice Address - Fax:214-890-9856
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1264535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist