Provider Demographics
NPI:1992831036
Name:YEAGER, SHELBY WYNETTE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:SHELBY
Middle Name:WYNETTE
Last Name:YEAGER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FREDERICK CT
Mailing Address - Street 2:
Mailing Address - City:ASHLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18706-2302
Mailing Address - Country:US
Mailing Address - Phone:570-239-9363
Mailing Address - Fax:
Practice Address - Street 1:2300 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-1514
Practice Address - Country:US
Practice Address - Phone:570-348-6211
Practice Address - Fax:570-961-4730
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001128A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer