Provider Demographics
NPI:1811749765
Name:YELTON, RACHAEL ANNE
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ANNE
Last Name:YELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-4123
Mailing Address - Country:US
Mailing Address - Phone:717-578-9674
Mailing Address - Fax:
Practice Address - Street 1:28059 US HIGHWAY 19 N STE 303A
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2620
Practice Address - Country:US
Practice Address - Phone:727-939-6095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL99799225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist