Provider Demographics
NPI:1235134768
Name:YOUNG, JOHN S (LPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:S
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 VILLAGE AT STONES CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5085
Mailing Address - Country:US
Mailing Address - Phone:610-252-4141
Mailing Address - Fax:
Practice Address - Street 1:304 VILLAGE AT STONES CROSSING RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5085
Practice Address - Country:US
Practice Address - Phone:610-252-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003401L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA474203Medicare PIN