Provider Demographics
NPI:1891586954
Name:YEZULINAS-BROWN, DESIREE
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:YEZULINAS-BROWN
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 1:501 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-1107
Mailing Address - Country:US
Mailing Address - Phone:570-573-6430
Mailing Address - Fax:570-573-6430
Practice Address - Street 1:501 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-1107
Practice Address - Country:US
Practice Address - Phone:570-573-6430
Practice Address - Fax:570-573-6430
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI004762225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant