Provider Demographics
NPI:1003140526
Name:SHIMKO, VICKI YANDELL (PT)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:YANDELL
Last Name:SHIMKO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:VICKI
Other - Middle Name:SUE
Other - Last Name:YANDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1009 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-2509
Mailing Address - Country:US
Mailing Address - Phone:570-368-8389
Mailing Address - Fax:570-368-8391
Practice Address - Street 1:1009 BROAD ST
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-2509
Practice Address - Country:US
Practice Address - Phone:570-368-8389
Practice Address - Fax:570-368-8391
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist