Basic Information
Provider Information
NPI: 1003005208
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YANGA-BARKSDALE
FirstName: THELMA
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2723 S 7TH STREET
Address2: SUITE A
City: TERRE HAUTE
State: IN
PostalCode: 478023558
CountryCode: US
TelephoneNumber: 8122381730
FaxNumber: 8122421565
Practice Location
Address1: 2723 S 7TH STREET
Address2: SUITE A
City: TERRE HAUTE
State: IN
PostalCode: 478023558
CountryCode: US
TelephoneNumber: 8122328164
FaxNumber: 8122346391
Other Information
ProviderEnumerationDate: 10/24/2007
LastUpdateDate: 06/16/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X05004037AINY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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