Provider Demographics
NPI:1497532162
Name:YOUNG, STEVEN C JR
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 N CRANBERRY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1246
Mailing Address - Country:US
Mailing Address - Phone:316-259-4878
Mailing Address - Fax:
Practice Address - Street 1:200 BEAUCHAMP STE 112
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-9157
Practice Address - Country:US
Practice Address - Phone:469-378-3464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-04143225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant