Provider Demographics
NPI:1770210486
Name:YEAGER, JOHNNA RAE (ATC, LAT)
Entity type:Individual
Prefix:
First Name:JOHNNA
Middle Name:RAE
Last Name:YEAGER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 ALTON RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1126
Mailing Address - Country:US
Mailing Address - Phone:606-627-8106
Mailing Address - Fax:
Practice Address - Street 1:725 ALTON RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1126
Practice Address - Country:US
Practice Address - Phone:606-627-8106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT15402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer