Provider Demographics
NPI:1063657567
Name:YOUNGBLOOD, CALEB LUCAS (DPT)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:LUCAS
Last Name:YOUNGBLOOD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5450 MACDONALD AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-5903
Mailing Address - Country:US
Mailing Address - Phone:305-294-8866
Mailing Address - Fax:305-294-8898
Practice Address - Street 1:10701 S OCEAN DR
Practice Address - Street 2:LOT 888
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-2641
Practice Address - Country:US
Practice Address - Phone:772-285-4984
Practice Address - Fax:772-413-7025
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 24611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist