Provider Demographics
NPI:1700835287
Name:YOUNG, PETER (PT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7107 MOONEY DR
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3425
Mailing Address - Country:US
Mailing Address - Phone:626-688-2973
Mailing Address - Fax:
Practice Address - Street 1:316 E LAS TUNAS DR STE 205
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1535
Practice Address - Country:US
Practice Address - Phone:626-451-9903
Practice Address - Fax:626-451-9937
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist