Provider Demographics
NPI:1851687669
Name:YOUNG, TYLER B (DPT)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:B
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30079-1133
Mailing Address - Country:US
Mailing Address - Phone:717-413-2959
Mailing Address - Fax:
Practice Address - Street 1:1368 SOUTHLAKE PLAZA DR
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1756
Practice Address - Country:US
Practice Address - Phone:678-422-8824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist