Active NPI
Yawtvaw Deetzaw Kedem
- Physical Therapy Assistant
- Gilbert, AZ
National Provider Identifier
1093054231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 10159A
- Practice address
- 3619 E Parkview Dr
Gilbert, AZ 85295-3699 - Phone
- (480) 907-9732
- NPI assigned
- Feb 7, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 10159A | AZ | Primary |
Addresses
Primary practice location
3619 E Parkview Dr
Gilbert, AZ 85295-3699
Mailing address
3619 E Parkview Dr
Gilbert, AZ 85295-3699
Phone (480) 907-9732
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10159A | AZ | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1360195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360195200000",
"number": "1093054231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3619 E PARKVIEW DR",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852953699",
"telephone_number": "480-907-9732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3619 E PARKVIEW DR",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852953699",
"telephone_number": "480-907-9732"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEDEM",
"first_name": "YAWTVAW",
"middle_name": "DEETZAW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-02-07",
"last_updated": "2013-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AZ",
"license": "10159A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gilbert, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.