Basic Information
Provider Information
NPI: 1003140526
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHIMKO
FirstName: VICKI
MiddleName: YANDELL
NamePrefix: MRS.
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: YANDELL
OtherFirstName: VICKI
OtherMiddleName: SUE
OtherNamePrefix: MISS
OtherNameSuffix:  
OtherCredential: PT
OtherLastNameType: 1
Mailing Information
Address1: 1009 BROAD ST
Address2:  
City: MONTOURSVILLE
State: PA
PostalCode: 177542509
CountryCode: US
TelephoneNumber: 5703688389
FaxNumber: 5703688391
Practice Location
Address1: 1009 BROAD ST
Address2:  
City: MONTOURSVILLE
State: PA
PostalCode: 177542509
CountryCode: US
TelephoneNumber: 5703688389
FaxNumber: 5703688391
Other Information
ProviderEnumerationDate: 09/30/2009
LastUpdateDate: 02/26/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT020192PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


Home