Provider Demographics
NPI:1528890332
Name:YACKOVICH, MCKENNA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:YACKOVICH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 RAYMALEY RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15636-1400
Mailing Address - Country:US
Mailing Address - Phone:724-787-8364
Mailing Address - Fax:
Practice Address - Street 1:4262 OLD WILLIAM PENN HWY STE 210
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1954
Practice Address - Country:US
Practice Address - Phone:724-387-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist