Provider Demographics
NPI:1023132826
Name:RECZEK, YAVETTE MICHELLE (LPTA)
Entity type:Individual
Prefix:MISS
First Name:YAVETTE
Middle Name:MICHELLE
Last Name:RECZEK
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4582 MILES DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-9242
Mailing Address - Country:US
Mailing Address - Phone:386-756-0436
Mailing Address - Fax:
Practice Address - Street 1:170 N CENTER ST
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5186
Practice Address - Country:US
Practice Address - Phone:386-672-7113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9178636163W00000X
FLPTA 18328225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant