Provider Demographics
NPI:1265838528
Name:YOUNG, COLLEEN H (LMT, CLT)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:H
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CORPORATE DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065
Mailing Address - Country:US
Mailing Address - Phone:518-663-6000
Mailing Address - Fax:518-665-3517
Practice Address - Street 1:9 CORPORATE DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-663-6000
Practice Address - Fax:518-665-3517
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027147225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY027147OtherNYS MASSAGE THERAPY