Provider Demographics
NPI:1033484712
Name:YOUNG, REBECCA (PTA/L)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 KEMPERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-8976
Mailing Address - Country:US
Mailing Address - Phone:304-280-7664
Mailing Address - Fax:
Practice Address - Street 1:4301 CLIME RD N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3403
Practice Address - Country:US
Practice Address - Phone:614-351-9470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07777225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant