Provider Demographics
NPI:1538348404
Name:YATES, MARGARET ROSE
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:ROSE
Last Name:YATES
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARGARET
Other - Middle Name:ANN
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:930 MILL HILL TERRACE
Mailing Address - Street 2:CONNECTICUT HEALTH OF SOUTHPORT
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06490
Mailing Address - Country:US
Mailing Address - Phone:203-259-7894
Mailing Address - Fax:
Practice Address - Street 1:930 MILL HILL TERRACE
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06490
Practice Address - Country:US
Practice Address - Phone:203-259-7894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist