Basic Information
| Provider Information | |||||||||
| NPI: | 1649229725 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOST | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | LOGAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 383 CORBIN CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | CORBIN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065262900 | ||||||||
| FaxNumber: | 6065262901 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 PROFESSIONAL LANE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | HARLAN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065739539 | ||||||||
| FaxNumber: | 6065737390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 07/30/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 004012 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8700142600 | 05 | KY | MEDICAID |