Provider Demographics
NPI:1851327126
Name:YACKOVICH, MICHELLE ANNETTE (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANNETTE
Last Name:YACKOVICH
Suffix:
Gender:F
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 1:1026 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15697-1360
Mailing Address - Country:US
Mailing Address - Phone:724-925-1944
Mailing Address - Fax:
Practice Address - Street 1:RR 4 BOX 2222
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-9041
Practice Address - Country:US
Practice Address - Phone:724-547-4100
Practice Address - Fax:724-547-0526
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer