Provider Demographics
NPI:1083698773
Name:YOUNG, RICHARD CARL (ATC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CARL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 CHAMBERLAIN ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1903
Mailing Address - Country:US
Mailing Address - Phone:207-989-4737
Mailing Address - Fax:207-581-3997
Practice Address - Street 1:5721 CUTLER HEALTH CTR
Practice Address - Street 2:UNIVERSITY OF MAINE
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04469-5721
Practice Address - Country:US
Practice Address - Phone:207-581-4184
Practice Address - Fax:207-581-3997
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer