Provider Demographics
NPI:1124374657
Name:YOUNG, DIANA LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 SCHERTZ PKWY
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1629
Mailing Address - Country:US
Mailing Address - Phone:469-334-7470
Mailing Address - Fax:
Practice Address - Street 1:4415 RIO D ORO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-6748
Practice Address - Country:US
Practice Address - Phone:210-248-9706
Practice Address - Fax:210-257-0268
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2003323225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant