Provider Demographics
NPI:1053494054
Name:YOUNG, REBECCA S (MSPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 DEEP RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-5381
Mailing Address - Country:US
Mailing Address - Phone:843-669-8841
Mailing Address - Fax:843-669-7144
Practice Address - Street 1:507 W CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4449
Practice Address - Country:US
Practice Address - Phone:843-669-8841
Practice Address - Fax:843-669-7144
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0126Medicaid