Provider Demographics
NPI:1922063932
Name:YOLITZ, LAURA M (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:YOLITZ
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 1:820 HOLLAND CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-3399
Mailing Address - Country:US
Mailing Address - Phone:770-946-8728
Mailing Address - Fax:770-460-6285
Practice Address - Street 1:135 BRANDYWINE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1590
Practice Address - Country:US
Practice Address - Phone:770-460-6285
Practice Address - Fax:770-460-6512
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0064032251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBDMNMedicare ID - Type Unspecified
GAP87720Medicare UPIN