Individual
TIMOTHY YATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
5528 MACCORKLE AVE SE, CHARLESTON, WV 25304-2320
(304) 720-5433
Mailing address
80 2ND ST, POCA, WV 25159-7208
(304) 546-9231
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1117
WV
Other
Enumeration date
02/18/2015
Last updated
02/18/2015
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