Provider Demographics
NPI:1487230595
Name:YOUNG, ABBY (LMT)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
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 1:830 E JOHNSTOWN RD STE D
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3815
Mailing Address - Country:US
Mailing Address - Phone:937-844-2798
Mailing Address - Fax:614-476-5991
Practice Address - Street 1:830 E JOHNSTOWN RD STE D
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3815
Practice Address - Country:US
Practice Address - Phone:937-844-2798
Practice Address - Fax:614-476-5991
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022149172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist