Provider Demographics
NPI:1669971511
Name:TORRES TAMAYO, YANIS M (LAT ATC)
Entity type:Individual
Prefix:
First Name:YANIS
Middle Name:M
Last Name:TORRES TAMAYO
Suffix:
Gender:F
Credentials:LAT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5226 TIMBERTOP LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7548
Mailing Address - Country:US
Mailing Address - Phone:704-488-2300
Mailing Address - Fax:
Practice Address - Street 1:5226 TIMBERTOP LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7548
Practice Address - Country:US
Practice Address - Phone:704-488-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23532255A2300X
NCLAT-32272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer