Provider Demographics
NPI:1497027940
Name:YASINSKI, CHARLES JEREMY (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JEREMY
Last Name:YASINSKI
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-3325
Mailing Address - Country:US
Mailing Address - Phone:717-832-0682
Mailing Address - Fax:
Practice Address - Street 1:1125 PARK DR
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-3447
Practice Address - Country:US
Practice Address - Phone:717-838-1331
Practice Address - Fax:717-833-5001
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001017A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer