Provider Demographics
NPI:1639100563
Name:YOUNG, CHRISTOPHER K (MPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:K
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 E MORELOS ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2245
Mailing Address - Country:US
Mailing Address - Phone:480-703-3114
Mailing Address - Fax:
Practice Address - Street 1:1534 E RAY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4429
Practice Address - Country:US
Practice Address - Phone:480-855-5542
Practice Address - Fax:480-855-5756
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ81368Medicaid
AZ81368Medicaid