Provider Demographics
NPI:1215192901
Name:YOUNG PHYSICAL THERAPY
Entity Type:Organization
Organization Name:YOUNG PHYSICAL THERAPY
Other - Org Name:YOUNG PHYSICAL THERAPY SPECIALTY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNGHOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:661-942-2202
Mailing Address - Street 1:PO BOX 5203
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539
Mailing Address - Country:US
Mailing Address - Phone:661-942-2202
Mailing Address - Fax:661-942-2203
Practice Address - Street 1:42301 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7000
Practice Address - Country:US
Practice Address - Phone:661-942-2202
Practice Address - Fax:661-942-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27406261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAX983OtherPROVIDER TRANSACTION ACCESS NUMBER(PTAN)