Provider Demographics
NPI:1205946969
Name:YANNACONE, CHRISTOPHER
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:YANNACONE
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 1:4606 CEDAR SPRINGS RD APT 1322
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-7207
Mailing Address - Country:US
Mailing Address - Phone:214-526-3064
Mailing Address - Fax:
Practice Address - Street 1:3107 W CAMP WISDOM RD
Practice Address - Street 2:SUITE 950
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2643
Practice Address - Country:US
Practice Address - Phone:214-339-4533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1135127OtherLICENSE #