Provider Demographics
NPI:1437329471
Name:YOUNG, JASON R (PT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3026 HIDDEN LAKE PT
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4455
Mailing Address - Country:US
Mailing Address - Phone:270-316-1499
Mailing Address - Fax:270-691-8929
Practice Address - Street 1:1605 SCHERM RD
Practice Address - Street 2:#3
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-5300
Practice Address - Country:US
Practice Address - Phone:270-685-9499
Practice Address - Fax:270-685-9443
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN225100000X
KY005135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN257250EMedicare PIN