Provider Demographics
NPI:1164882080
Name:YOUNG, TERRY E (LPTA)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:E
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5949 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-8527
Mailing Address - Country:US
Mailing Address - Phone:952-472-3631
Mailing Address - Fax:
Practice Address - Street 1:5949 HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:MOUND
Practice Address - State:MN
Practice Address - Zip Code:55364-8527
Practice Address - Country:US
Practice Address - Phone:952-472-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA353225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA353OtherPTA LICENSURE