Provider Demographics
NPI:1104868066
Name:YOUNGBLOOD, KARI MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:MARIE
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 WELLES ST
Mailing Address - Street 2:SUITE 166
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4968
Mailing Address - Country:US
Mailing Address - Phone:570-714-4177
Mailing Address - Fax:570-714-4188
Practice Address - Street 1:190 WELLES ST
Practice Address - Street 2:SUITE 166
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4968
Practice Address - Country:US
Practice Address - Phone:570-714-4177
Practice Address - Fax:570-714-4188
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist