Provider Demographics
NPI:1255971271
Name:TESFAYE, YOHANA (PT)
Entity type:Individual
Prefix:
First Name:YOHANA
Middle Name:
Last Name:TESFAYE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 HILLSDALE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3255
Mailing Address - Country:US
Mailing Address - Phone:408-771-9310
Mailing Address - Fax:
Practice Address - Street 1:1642 HILLSDALE AVE APT 3
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3255
Practice Address - Country:US
Practice Address - Phone:408-771-9310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist