Provider Demographics
NPI:1073874053
Name:YOUNGERS, TAYLOR R (LMP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:R
Last Name:YOUNGERS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 NOB HILL DR
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1752
Mailing Address - Country:US
Mailing Address - Phone:509-237-3977
Mailing Address - Fax:
Practice Address - Street 1:51 ALDER ST NW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1663
Practice Address - Country:US
Practice Address - Phone:509-754-3295
Practice Address - Fax:509-754-3296
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60291514225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist