Provider Demographics
NPI:1003076118
Name:YOUNG, JONATHAN KEITH (DPT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:KEITH
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5500 BROOKTREE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9260
Mailing Address - Country:US
Mailing Address - Phone:724-941-3100
Mailing Address - Fax:724-941-1575
Practice Address - Street 1:1290 BOYCE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-3921
Practice Address - Country:US
Practice Address - Phone:724-941-3100
Practice Address - Fax:724-941-1575
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist