Provider Demographics
NPI:1275630428
Name:YOUNGER, JAMES KEVIN (MPT, MTC, STC, CPI)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KEVIN
Last Name:YOUNGER
Suffix:
Gender:M
Credentials:MPT, MTC, STC, CPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 W 10TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2047
Mailing Address - Country:US
Mailing Address - Phone:970-346-6116
Mailing Address - Fax:970-346-1226
Practice Address - Street 1:4835 W 10TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2047
Practice Address - Country:US
Practice Address - Phone:970-346-6116
Practice Address - Fax:970-346-1226
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO61552251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO465408Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER