Provider Demographics
NPI:1366648495
Name:YOUNG, JAMES ANTHONY (PTA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ANTHONY
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 SEA PINE WAY
Mailing Address - Street 2:APT E-2
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33415-8942
Mailing Address - Country:US
Mailing Address - Phone:315-408-3113
Mailing Address - Fax:
Practice Address - Street 1:7410 BOYNTON BEACH BLVD
Practice Address - Street 2:BAY A-11
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-6156
Practice Address - Country:US
Practice Address - Phone:561-731-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 20802225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant