Provider Demographics
NPI:1295006591
Name:YOUNG, DAWN MICHELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MICHELLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:MICHELLE
Other - Last Name:RYKIEL-YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:16 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-3334
Mailing Address - Country:US
Mailing Address - Phone:732-918-8162
Mailing Address - Fax:
Practice Address - Street 1:3349 HIGHWAY 138
Practice Address - Street 2:BUILDING B SUITE A
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-9671
Practice Address - Country:US
Practice Address - Phone:732-280-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QAO07437002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics