Provider Demographics
NPI:1689111650
Name:YOUNG, STEVEN DANIEL (MAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:DANIEL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8808 COLUMBIA AVE
Mailing Address - Street 2:JOSEPH WILLIS ATHLETIC TRAINING FACILITY
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:208-242-6052
Mailing Address - Fax:
Practice Address - Street 1:8808 COLUMBIA AVE
Practice Address - Street 2:JOSEPH WILLIS ATHLETIC TRAINING FACILITY
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:208-242-6052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002904A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer