Active NPI
Yvette Provosty
- Physical Therapist
- Medford, OR
National Provider Identifier
1689105454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 04969
- Practice address
- 400 Crater Lake Ave
Medford, OR 97504-6808 - Phone
- (541) 613-6505
- Fax
- (541) 770-9212
- NPI assigned
- Mar 23, 2017
- Last updated
- Mar 23, 2017
- 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 Therapist | 225100000X | 04969 | OR | Primary |
Addresses
Primary practice location
400 Crater Lake Ave
Medford, OR 97504-6808
Mailing address
610 High St
Oregon City, OR 97045-2241
Phone (503) 657-8903
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 |
|---|---|---|---|
| 04969 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490227200000",
"number": "1689105454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 HIGH ST",
"city": "OREGON CITY",
"state": "OR",
"postal_code": "970452241",
"telephone_number": "503-657-8903",
"fax_number": "503-650-4302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 CRATER LAKE AVE",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975046808",
"telephone_number": "541-613-6505",
"fax_number": "541-770-9212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVOSTY",
"first_name": "YVETTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-03-23",
"last_updated": "2017-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "04969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
- Providence Health & Services Oregon (Providence Medical Group South)
- Providence Health & Services Oregon (Prov Health Sys-OR Shared-Svs Div)
- Providence Health & Services Oregon (PMG Gastroenterology)
- Providence Hospitalists & Intensivists
- Providence Medford Medical Center (Providence Medford Medical Center Lifeline)
- Jon D Prulhiere, MD
- Travis Robert Psota, B.S., QMHA
- Psychological Health Collective LLP
- Yolanda Puga
- Tamara Marie Pugh
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.