Provider Demographics
NPI:1568655363
Name:YOUNG, CHRISTENE L
Entity Type:Individual
Prefix:
First Name:CHRISTENE
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52435 INFIRMARY RD
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MO
Mailing Address - Zip Code:63556-2874
Mailing Address - Country:US
Mailing Address - Phone:660-265-4032
Mailing Address - Fax:660-265-5352
Practice Address - Street 1:52435 INFIRMARY RD
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MO
Practice Address - Zip Code:63556-2874
Practice Address - Country:US
Practice Address - Phone:660-265-4032
Practice Address - Fax:660-265-5352
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117793225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant