Provider Demographics
NPI:1710349097
Name:YOUNG, SARA ASHLEY (PT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ASHLEY
Last Name:YOUNG
Suffix:
Gender:F
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:PO BOX 1590
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-1590
Mailing Address - Country:US
Mailing Address - Phone:803-358-9400
Mailing Address - Fax:803-358-9898
Practice Address - Street 1:364 LONGS POND RD
Practice Address - Street 2:STE H
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7400
Practice Address - Country:US
Practice Address - Phone:803-358-9400
Practice Address - Fax:803-358-9898
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist