Provider Demographics
NPI:1942323035
Name:YANDELL, MERRITT (PT)
Entity Type:Individual
Prefix:MS
First Name:MERRITT
Middle Name:
Last Name:YANDELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MERRITT
Other - Middle Name:
Other - Last Name:YANDELL-AHMAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:502-576-3282
Mailing Address - Fax:
Practice Address - Street 1:3525 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2140
Practice Address - Country:US
Practice Address - Phone:608-467-3537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008556225100000X
WI10179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist