Provider Demographics
NPI:1821850967
Name:YOUNGBLOOD PHYSICAL THERAPY & SPORTS PERFORMANCE, LLC
Entity Type:Organization
Organization Name:YOUNGBLOOD PHYSICAL THERAPY & SPORTS PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:YOUNGBLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:806-683-0711
Mailing Address - Street 1:5440 ANITA ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5336
Mailing Address - Country:US
Mailing Address - Phone:806-683-0711
Mailing Address - Fax:
Practice Address - Street 1:11661 PRESTON RD STE 175
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6181
Practice Address - Country:US
Practice Address - Phone:806-683-0711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy