Basic Information
| Provider Information | |||||||||
| NPI: | 1700344314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YU | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 COTTONWOOD BUILDING | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170572504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106601731 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2913 SPOOKY NOOK RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | MANHEIM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175459149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172994871 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2019 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2255A2300X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.