Provider Demographics
NPI:1902528987
Name:YERGEAU, KAYLEE ANN (DPT)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:ANN
Last Name:YERGEAU
Suffix:
Gender:F
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:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-0003
Mailing Address - Country:US
Mailing Address - Phone:304-636-2340
Mailing Address - Fax:304-636-1583
Practice Address - Street 1:1620 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-8502
Practice Address - Country:US
Practice Address - Phone:304-636-2340
Practice Address - Fax:304-636-1583
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT004560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist