Provider Demographics
NPI:1699823898
Name:YOUTHFUL HORIZONS PHYSICAL THERAPY, PS
Entity Type:Organization
Organization Name:YOUTHFUL HORIZONS PHYSICAL THERAPY, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:OWAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-921-9798
Mailing Address - Street 1:325 S UNIVERSITY RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5227
Mailing Address - Country:US
Mailing Address - Phone:509-921-9798
Mailing Address - Fax:509-921-9774
Practice Address - Street 1:325 S UNIVERSITY RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5227
Practice Address - Country:US
Practice Address - Phone:509-921-9798
Practice Address - Fax:509-921-9774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602035467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherTAX ID