Provider Demographics
NPI:1528371952
Name:YANABU, STEPHANIE TAMI MEI LIN (DPT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TAMI MEI LIN
Last Name:YANABU
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:TAMI MEI LIN
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:3925 159TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6309
Practice Address - Country:US
Practice Address - Phone:425-216-0550
Practice Address - Fax:425-216-0551
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60161869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1528371952Medicaid
WAP00964318OtherMEDICARE RAILROAD
WA0291642OtherDEPT. OF LABOR AND INDUSTRIES
WAP00964318OtherMEDICARE RAILROAD