Basic Information
| Provider Information | |||||||||
| NPI: | 1518314871 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YEOMAN | ||||||||
| FirstName: | SAMANTHA | ||||||||
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| Credential: | MS, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1224 E LOWELL ST BLDG 95 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857210095 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1224 E LOWELL ST BLDG 95 | ||||||||
| Address2: | ROOM C132B | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857210095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206219013 | ||||||||
| FaxNumber: | 5206262416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2016 | ||||||||
| LastUpdateDate: | 05/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 1236 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
ID Information
| ID | Type | State | Issuer | Description | 2000013158 | 01 | BOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER | OTHER | 1236 | 01 | AZ | ARIZONA STATE BOARD OF ATHLETIC TRAINING | OTHER |