Provider Demographics
NPI:1356523088
Name:YAYAC, CATHI J (ATC)
Entity type:Individual
Prefix:MS
First Name:CATHI
Middle Name:J
Last Name:YAYAC
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 SUMMIT AVE
Mailing Address - Street 2:PO BOX 65
Mailing Address - City:ISLAND HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08732-7898
Mailing Address - Country:US
Mailing Address - Phone:732-506-9039
Mailing Address - Fax:
Practice Address - Street 1:101 S COLONIAL DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NJ
Practice Address - Zip Code:08759-6401
Practice Address - Country:US
Practice Address - Phone:732-657-0244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000137002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer