Provider Demographics
NPI:1245407907
Name:YOUNG, SHAUNDA GAYLE (MSPT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:SHAUNDA
Middle Name:GAYLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1262 BERGEN PKWY
Mailing Address - Street 2:BUILDING E-10
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9546
Mailing Address - Country:US
Mailing Address - Phone:303-674-7889
Mailing Address - Fax:
Practice Address - Street 1:1262 BERGEN PKWY
Practice Address - Street 2:BUILDING E-10
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9546
Practice Address - Country:US
Practice Address - Phone:303-674-7889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9066261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy