Provider Demographics
NPI:1598274169
Name:YOUNG, ERIC KEITH
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:KEITH
Last Name:YOUNG
Suffix:
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 1:829 S MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1821
Mailing Address - Country:US
Mailing Address - Phone:253-365-9804
Mailing Address - Fax:253-838-0505
Practice Address - Street 1:622 S 320TH ST STE B
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5263
Practice Address - Country:US
Practice Address - Phone:253-838-7300
Practice Address - Fax:253-838-0505
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60681717225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty