Provider Demographics
NPI:1871987958
Name:YORTON, DAWN (C-PED, ATC)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:YORTON
Suffix:
Gender:F
Credentials:C-PED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10532 LITTLE FAWN CT
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48850-9326
Mailing Address - Country:US
Mailing Address - Phone:616-498-2687
Mailing Address - Fax:
Practice Address - Street 1:5147 E PARIS AVE SE
Practice Address - Street 2:SUITE 21
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-5457
Practice Address - Country:US
Practice Address - Phone:616-356-5030
Practice Address - Fax:616-656-5442
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224L00000X
MI36402002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer