Provider Demographics
NPI:1174605406
Name:SARDILLO, YVETTE B (PT)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:B
Last Name:SARDILLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17270 BEAR VALLEY RD
Mailing Address - Street 2:STE 105
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7751
Mailing Address - Country:US
Mailing Address - Phone:760-245-8828
Mailing Address - Fax:855-891-9996
Practice Address - Street 1:17270 BEAR VALLEY RD
Practice Address - Street 2:STE 105
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7751
Practice Address - Country:US
Practice Address - Phone:760-245-8828
Practice Address - Fax:855-891-9996
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00279476OtherRAILROAD MC
CAPT0189560Medicaid
P33225Medicare UPIN
CAOPT189561Medicare ID - Type Unspecified