Provider Demographics
NPI:1740909993
Name:YODER, CARLY ANN
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ANN
Last Name:YODER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:ANN
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:
Practice Address - Street 1:270 SUSQUEHANNA VALLEY MALL DR STE 400
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9115
Practice Address - Country:US
Practice Address - Phone:570-884-7940
Practice Address - Fax:570-884-8360
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT030920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist