Provider Demographics
NPI:1356628580
Name:YOUNG, CHARLENE FRANCES (LMT)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:FRANCES
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-1620
Mailing Address - Country:US
Mailing Address - Phone:614-440-1706
Mailing Address - Fax:
Practice Address - Street 1:315 S 21ST AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-5011
Practice Address - Country:US
Practice Address - Phone:614-440-1706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA28394172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist