Provider Demographics
NPI:1689944597
Name:YOUNG, ANGELICA MARIA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:MARIA
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 1:814 MAPLE AVE N
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-3019
Mailing Address - Country:US
Mailing Address - Phone:239-369-2555
Mailing Address - Fax:239-790-0895
Practice Address - Street 1:814 MAPLE AVE N
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-3019
Practice Address - Country:US
Practice Address - Phone:239-369-2555
Practice Address - Fax:239-790-0895
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA22877225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant