Provider Demographics
NPI:1871948315
Name:DREPTATE, YVONNE (LMT)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:DREPTATE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2985 DISTRICT AVE
Mailing Address - Street 2:UNIT 687
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1541
Mailing Address - Country:US
Mailing Address - Phone:570-730-1953
Mailing Address - Fax:
Practice Address - Street 1:2985 DISTRICT AVE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-1541
Practice Address - Country:US
Practice Address - Phone:443-406-8339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019007455225700000X
TXMT107551225700000X
MDMD # R02177225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist