Provider Demographics
NPI:1770898470
Name:YAGLE, TAMRA LYNNE (PTA)
Entity type:Individual
Prefix:MS
First Name:TAMRA
Middle Name:LYNNE
Last Name:YAGLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9350
Mailing Address - Country:US
Mailing Address - Phone:502-419-4318
Mailing Address - Fax:
Practice Address - Street 1:5006 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-9350
Practice Address - Country:US
Practice Address - Phone:502-419-4318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06000783A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant