Provider Demographics
NPI:1578708160
Name:YOUNG, JOHANNA RACHEL (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:RACHEL
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 CORNERSTONE XING
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-4562
Mailing Address - Country:US
Mailing Address - Phone:262-514-0120
Mailing Address - Fax:
Practice Address - Street 1:808 CORNERSTONE XING
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-4562
Practice Address - Country:US
Practice Address - Phone:262-514-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1178-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant