Provider Demographics
NPI:1790954089
Name:YOUNG, JAYNA C (LMT)
Entity Type:Individual
Prefix:MS
First Name:JAYNA
Middle Name:C
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PERRIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-2122
Mailing Address - Country:US
Mailing Address - Phone:585-750-5813
Mailing Address - Fax:
Practice Address - Street 1:220 VILLAGE LNDG
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1806
Practice Address - Country:US
Practice Address - Phone:585-388-6343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019576172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist