Provider Demographics
NPI:1609835297
Name:IVANOV, YVONNE MARIE (RPT)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:MARIE
Last Name:IVANOV
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 OAKHURST RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-2721
Mailing Address - Country:US
Mailing Address - Phone:508-254-9162
Mailing Address - Fax:
Practice Address - Street 1:209 W CENTRAL ST
Practice Address - Street 2:STE 313
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3765
Practice Address - Country:US
Practice Address - Phone:800-834-3997
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist