Provider Demographics
NPI:1205500600
Name:YOEST, EDWARD JACOB (PTA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JACOB
Last Name:YOEST
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:PA
Mailing Address - Zip Code:18810-1614
Mailing Address - Country:US
Mailing Address - Phone:570-731-6919
Mailing Address - Fax:570-731-6917
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:PA
Practice Address - Zip Code:18810-1614
Practice Address - Country:US
Practice Address - Phone:570-731-6919
Practice Address - Fax:570-731-6917
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant