Provider Demographics
NPI:1225214638
Name:YBARRA, TAWNI JO RANDALL (PT)
Entity type:Individual
Prefix:
First Name:TAWNI
Middle Name:JO RANDALL
Last Name:YBARRA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TAWNI
Other - Middle Name:JO
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2020 SCULPIN CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4545
Mailing Address - Country:US
Mailing Address - Phone:831-239-2002
Mailing Address - Fax:
Practice Address - Street 1:2020 SCULPIN CT
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4545
Practice Address - Country:US
Practice Address - Phone:312-392-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34332225100000X
CA34332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist