Basic Information
| Provider Information | |||||||||
| NPI: | 1871987958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YORTON | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | C-PED, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10532 LITTLE FAWN CT | ||||||||
| Address2: | |||||||||
| City: | LAKEVIEW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488509326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164982687 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5147 E PARIS AVE SE | ||||||||
| Address2: | SUITE 21 | ||||||||
| City: | KENTWOOD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495125457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163565030 | ||||||||
| FaxNumber: | 6166565442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2015 | ||||||||
| LastUpdateDate: | 03/26/2015 | ||||||||
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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 | 224L00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Pedorthist | 2255A2300X | 3640200 | MI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.