Healthcare Provider Details

I. General information

NPI: 1790605285
Provider Name (Legal Business Name): SAMUEL YOURKO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 CLARK ST
CAMBRIDGE OH
43725-9614
US

IV. Provider business mailing address

443 1/2 E MAIN ST
BARNESVILLE OH
43713
US

V. Phone/Fax

Practice location:
  • Phone: 740-439-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT007330
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: