Provider Demographics
NPI:1962690115
Name:FAWZI, YVETTE VERONIQUE (MPT, GCFP)
Entity type:Individual
Prefix:MRS
First Name:YVETTE
Middle Name:VERONIQUE
Last Name:FAWZI
Suffix:
Gender:F
Credentials:MPT, GCFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 BUSH ST
Mailing Address - Street 2:STE 650
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5999
Mailing Address - Country:US
Mailing Address - Phone:415-441-5800
Mailing Address - Fax:
Practice Address - Street 1:1199 BUSH ST
Practice Address - Street 2:STE 650
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5999
Practice Address - Country:US
Practice Address - Phone:415-441-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT1956BOtherPT LICENSE