Provider Demographics
NPI:1982932927
Name:YLISTO, BRIAN M (DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:YLISTO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4814
Mailing Address - Country:US
Mailing Address - Phone:912-355-0123
Mailing Address - Fax:912-355-3856
Practice Address - Street 1:911 E 70TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4814
Practice Address - Country:US
Practice Address - Phone:912-355-0123
Practice Address - Fax:912-355-3856
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009824174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist