Individual
LISA GWEN YIRKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
800 TUCKER RD, TOLEDO, WA 98591-8685
(360) 623-0319
Mailing address
800 TUCKER RD, TOLEDO, WA 98591-8685
(360) 623-0319
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
P160031772
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P160031772
PTA LICENSE
WA
Enumeration date
09/26/2008
Last updated
09/26/2008
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