Provider Demographics
NPI:1174820005
Name:YOUNG, ANTHONY B (PT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:B
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 S LA SALLE ST
Mailing Address - Street 2:STE 503
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-1444
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:212 N CARPENTER ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1713
Practice Address - Country:US
Practice Address - Phone:708-460-8588
Practice Address - Fax:708-460-8788
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist