Individual
MARA LYNN YATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
7878 N 76TH ST, MILWAUKEE, WI 53223-3914
(414) 586-5760
(414) 586-5740
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 586-5710
(414) 586-5740
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
13154
WI
225100000X
Physical Therapist
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100048344
—
WI
Enumeration date
08/12/2015
Last updated
12/08/2021
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