Provider Demographics
NPI:1932510419
Name:YU, AUDREY (PT, MHS, PCS)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:PT, MHS, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 PINE ST
Mailing Address - Street 2:APT 5
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-2213
Mailing Address - Country:US
Mailing Address - Phone:203-249-2065
Mailing Address - Fax:
Practice Address - Street 1:32 PINE ST
Practice Address - Street 2:APT 5
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-2213
Practice Address - Country:US
Practice Address - Phone:203-249-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-18
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0046172251P0200X
NY016120-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics