Provider Demographics
NPI:1912066069
Name:YACCARINO, PAMELA KAY (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KAY
Last Name:YACCARINO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VANDERBILT PARK
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803
Mailing Address - Country:US
Mailing Address - Phone:828-277-6957
Mailing Address - Fax:828-277-6960
Practice Address - Street 1:1 VANDERBILT PARK
Practice Address - Street 2:SUITE 120
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-277-6957
Practice Address - Fax:828-277-6960
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2507091Medicare PIN