Provider Demographics
NPI:1952814592
Name:YODER, BRENT ANTHONY (DPT, CERTDN)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:ANTHONY
Last Name:YODER
Suffix:
Gender:M
Credentials:DPT, CERTDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 PONDER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6632
Mailing Address - Country:US
Mailing Address - Phone:941-809-6347
Mailing Address - Fax:
Practice Address - Street 1:905B PONDER AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6632
Practice Address - Country:US
Practice Address - Phone:941-220-5206
Practice Address - Fax:941-313-7106
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2022-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT33172OtherSTATE LICENSE