Provider Demographics
NPI:1922489202
Name:GREEN, YAEL (DPT)
Entity Type:Individual
Prefix:
First Name:YAEL
Middle Name:
Last Name:GREEN
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 1:1045 N KINGS RD APT 103
Mailing Address - Street 2:NONE
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-6002
Mailing Address - Country:US
Mailing Address - Phone:310-388-7129
Mailing Address - Fax:
Practice Address - Street 1:1045 N KINGS RD APT 103
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-6002
Practice Address - Country:US
Practice Address - Phone:310-388-7129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist