Provider Demographics
NPI:1649629536
Name:YANG, KATHY (CMT)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2781 FREEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1753
Mailing Address - Country:US
Mailing Address - Phone:763-244-8022
Mailing Address - Fax:763-244-8021
Practice Address - Street 1:2781 FREEWAY BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-1753
Practice Address - Country:US
Practice Address - Phone:763-244-8022
Practice Address - Fax:763-244-8021
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist