Provider Demographics
NPI:1992168074
Name:ROSENTHAL, YAFFA
Entity type:Individual
Prefix:
First Name:YAFFA
Middle Name:
Last Name:ROSENTHAL
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:PO BOX 1084
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-1084
Mailing Address - Country:US
Mailing Address - Phone:541-621-9343
Mailing Address - Fax:
Practice Address - Street 1:1391 EVERGREEN LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1677
Practice Address - Country:US
Practice Address - Phone:541-621-9343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist