Provider Demographics
NPI:1134572084
Name:YANDEK, JOHN RAYMOND
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RAYMOND
Last Name:YANDEK
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 1:15601 REDINGTON DR
Mailing Address - Street 2:
Mailing Address - City:REDINGTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1739
Mailing Address - Country:US
Mailing Address - Phone:727-512-4316
Mailing Address - Fax:
Practice Address - Street 1:15601 REDINGTON DR
Practice Address - Street 2:
Practice Address - City:REDINGTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33708-1739
Practice Address - Country:US
Practice Address - Phone:727-512-4316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26802225200000X
GAPTA003680225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA26802OtherSTATE OF FL - DEPARTMENT OF HEALTH
GAPTA003680OtherGA SECRETARY OF STATE