MEDICARE: MR. CHRISTOPHER LEE YARTYM ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	000659-1	NY

General Provider Information

NPI Number	:	1699749473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER LEE YARTYM ATC

Provider Business Mailing Address
First Line	:	34 SHANNON ST
Second Line	:
City	:	BATH
State	:	NY
Zip	:	14810-1241
Country	:	US
Telephone Number	:	607-776-4728
Fax Number	:	607-871-2607

Provider Business Practice Location Address
First Line	:	1 SAXON DR
Second Line	:	ALFRED UNIVERSITY
City	:	ALFRED
State	:	NY
Zip	:	14802-1205
Country	:	US
Telephone Number	:	607-871-2902
Fax Number	:	607-871-2607

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	07/08/2007

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