Provider Demographics
NPI:1386974996
Name:HYDE, YVONNE C (PT)
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:C
Last Name:HYDE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1393 NY HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:PETERSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12138-6027
Mailing Address - Country:US
Mailing Address - Phone:518-658-0003
Mailing Address - Fax:
Practice Address - Street 1:160 BENMONT AVE
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1873
Practice Address - Country:US
Practice Address - Phone:802-442-5502
Practice Address - Fax:802-442-4919
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003766225100000X
NY7237225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist