Provider Demographics
NPI:1396580023
Name:SLIDER, YVONNE DESHEL (NASM CPT AND CES)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:DESHEL
Last Name:SLIDER
Suffix:
Gender:F
Credentials:NASM CPT AND CES
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:SLIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 N MAIN ST APT 1119
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3947
Mailing Address - Country:US
Mailing Address - Phone:817-615-1946
Mailing Address - Fax:
Practice Address - Street 1:285 SHADY OAKS DR
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6150
Practice Address - Country:US
Practice Address - Phone:817-615-1946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12310219052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer