Provider Demographics
NPI:1720140965
Name:YAVER, JEFFREY BRIAN (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:BRIAN
Last Name:YAVER
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 1:20533 NOB HILL CIR
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:CA
Mailing Address - Zip Code:95321-9576
Mailing Address - Country:US
Mailing Address - Phone:209-962-0556
Mailing Address - Fax:
Practice Address - Street 1:1721 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5130
Practice Address - Country:US
Practice Address - Phone:209-824-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist