Provider Demographics
NPI:1164579579
Name:YOUNG, STEVE (DPT)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 COOPER ROAD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4305
Mailing Address - Country:US
Mailing Address - Phone:856-751-8881
Mailing Address - Fax:856-751-8810
Practice Address - Street 1:805 COOPER ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4305
Practice Address - Country:US
Practice Address - Phone:856-751-8881
Practice Address - Fax:856-751-8810
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA009827225100000X
NJ40QA00982700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ058518TZ2Medicare ID - Type Unspecified