Provider Demographics
NPI:1427600535
Name:CALEB YOUNGBLOOD P.T. INC
Entity Type:Organization
Organization Name:CALEB YOUNGBLOOD P.T. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:LUCAS
Authorized Official - Last Name:YOUNGBLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:772-285-4984
Mailing Address - Street 1:10701 S OCEAN DR LOT 888
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-2641
Mailing Address - Country:US
Mailing Address - Phone:772-285-4984
Mailing Address - Fax:
Practice Address - Street 1:10701 S OCEAN DR LOT 888
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-2641
Practice Address - Country:US
Practice Address - Phone:772-285-4984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT24611OtherLICENSE