Provider Demographics
NPI:1326714981
Name:YOUNG, KRISTY DAWN (LPTA)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:DAWN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1895
Mailing Address - Street 2:
Mailing Address - City:WALDRON
Mailing Address - State:AR
Mailing Address - Zip Code:72958-1895
Mailing Address - Country:US
Mailing Address - Phone:479-227-0903
Mailing Address - Fax:
Practice Address - Street 1:816 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-3423
Practice Address - Country:US
Practice Address - Phone:479-268-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1929225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant