Provider Demographics
NPI:1457628729
Name:YOUNG, TROY (PT, DPT, CERT ART)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PT, DPT, CERT ART
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6983 LAGOON CT
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91752-2783
Mailing Address - Country:US
Mailing Address - Phone:714-767-3828
Mailing Address - Fax:
Practice Address - Street 1:2000 GLEN ECHO RD STE 209
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2898
Practice Address - Country:US
Practice Address - Phone:615-840-3281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 350832251X0800X
TN143252251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ075098Medicaid