Provider Demographics
NPI:1124326673
Name:EWENS, YVETTE PIENIADZ (PT, DPT)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:PIENIADZ
Last Name:EWENS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:YVETTE
Other - Middle Name:
Other - Last Name:PIENIADZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:65 E WADSWORTH PARK DR STE 230
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8096
Mailing Address - Country:US
Mailing Address - Phone:385-308-8034
Mailing Address - Fax:
Practice Address - Street 1:863 W OGLETHORPE HWY STE 210
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4491
Practice Address - Country:US
Practice Address - Phone:912-368-0534
Practice Address - Fax:912-368-0537
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL11117225100000X
VA2305214647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist