Provider Demographics
NPI:1699871830
Name:YANTIS, DIANA DUKE (PTA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:DUKE
Last Name:YANTIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 BIG CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379
Mailing Address - Country:US
Mailing Address - Phone:423-332-4158
Mailing Address - Fax:
Practice Address - Street 1:360 DELL TRL
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-5511
Practice Address - Country:US
Practice Address - Phone:423-949-4651
Practice Address - Fax:423-242-7103
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN317225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant