Provider Demographics
NPI:1710731708
Name:YOUNG, CORY M (LMT)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 LAKE TAPPS PKWY SE STE F104
Mailing Address - Street 2:245
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8157
Mailing Address - Country:US
Mailing Address - Phone:682-401-8979
Mailing Address - Fax:
Practice Address - Street 1:15610 SE 272ND ST BLDG A
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4416
Practice Address - Country:US
Practice Address - Phone:253-638-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61232396225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist