Provider Demographics
NPI:1750654406
Name:YOUNGS, NICOLE S (PT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:S
Last Name:YOUNGS
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 1:700 THORNBERRY TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452-8508
Mailing Address - Country:US
Mailing Address - Phone:330-549-6029
Mailing Address - Fax:
Practice Address - Street 1:1419 BOARDMAN CANFIELD RD
Practice Address - Street 2:SUITE300
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-8062
Practice Address - Country:US
Practice Address - Phone:330-953-2383
Practice Address - Fax:330-953-2384
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist