Provider Demographics
NPI:1063275238
Name:DRUCK, YSA (ATC)
Entity type:Individual
Prefix:
First Name:YSA
Middle Name:
Last Name:DRUCK
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 1:14 STEPHENS CT
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:CA
Mailing Address - Zip Code:94525-1420
Mailing Address - Country:US
Mailing Address - Phone:510-367-7899
Mailing Address - Fax:
Practice Address - Street 1:150 3RD ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4126
Practice Address - Country:US
Practice Address - Phone:510-367-7899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANONE204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty