Provider Demographics
NPI:1194035006
Name:YOUNG, NANCY (PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5782
Mailing Address - Country:US
Mailing Address - Phone:865-988-3925
Mailing Address - Fax:865-988-6986
Practice Address - Street 1:460 MEDICAL PARK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5782
Practice Address - Country:US
Practice Address - Phone:865-988-3925
Practice Address - Fax:865-988-6986
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3653166Medicaid
TN4281759OtherBLUECROSS BLUESHIELD
TN103I658725Medicare PIN