Provider Demographics
NPI:1083935712
Name:YOUNG, JONATHAN (PT/DPT)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PT/DPT
Other - Prefix:
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:242 N WINTERSET ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6379
Mailing Address - Country:US
Mailing Address - Phone:316-650-5956
Mailing Address - Fax:
Practice Address - Street 1:242 N WINTERSET ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-6379
Practice Address - Country:US
Practice Address - Phone:316-650-5956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist