Provider Demographics
NPI:1104641877
Name:YANKOVICH, JARED FRANCIS
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:FRANCIS
Last Name:YANKOVICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-7866
Mailing Address - Country:US
Mailing Address - Phone:913-894-6106
Mailing Address - Fax:
Practice Address - Street 1:253 GRANADA DR STE D
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7340
Practice Address - Country:US
Practice Address - Phone:805-543-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41949225100000X
NCP23554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist