Healthcare Provider Details

I. General information

NPI: 1871987958
Provider Name (Legal Business Name): DAWN YORTON C-PED, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5147 E PARIS AVE SE SUITE 21
KENTWOOD MI
49512-5457
US

IV. Provider business mailing address

10532 LITTLE FAWN CT
LAKEVIEW MI
48850-9326
US

V. Phone/Fax

Practice location:
  • Phone: 616-356-5030
  • Fax: 616-656-5442
Mailing address:
  • Phone: 616-498-2687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number3640200
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: