Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT020192 | PA |
NPI | 1003140526 |
---|---|
Provider Name | Mrs. Vicki Yandell Shimko |
First Address | Montoursville, PA 17754-2509 |
Second Address | Montoursville, PA 17754-2509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2009 |
Last Update Date | 26/02/2010 |