Provider Demographics
NPI:1871228148
Name:YODER, ROBERT J (LMT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:YODER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1802 CHAPEL HILLS DR STE E
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3736
Mailing Address - Country:US
Mailing Address - Phone:719-531-7188
Mailing Address - Fax:719-531-0880
Practice Address - Street 1:2620 TENDERFOOT HILL ST STE 10
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-8354
Practice Address - Country:US
Practice Address - Phone:719-527-6747
Practice Address - Fax:719-579-9623
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COMT0020138225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist