Provider Demographics
NPI:1255804431
Name:VANBRAKLE, YRIS (PTA)
Entity type:Individual
Prefix:
First Name:YRIS
Middle Name:
Last Name:VANBRAKLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:YRIS
Other - Middle Name:
Other - Last Name:VANBRAKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:310 64TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2393
Mailing Address - Country:US
Mailing Address - Phone:646-270-4937
Mailing Address - Fax:973-228-2311
Practice Address - Street 1:355 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5118
Practice Address - Country:US
Practice Address - Phone:973-228-0072
Practice Address - Fax:973-228-2311
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00267800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant