Provider Demographics
NPI:1891782231
Name:YOUNG, GEORGE SIDNEY (MS, DPT, OCS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:SIDNEY
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MS, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5122 KATELLA AVE
Mailing Address - Street 2:STE 16
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2838
Mailing Address - Country:US
Mailing Address - Phone:562-795-5295
Mailing Address - Fax:562-795-5297
Practice Address - Street 1:5122 KATELLA AVE
Practice Address - Street 2:STE 16
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2838
Practice Address - Country:US
Practice Address - Phone:562-795-5295
Practice Address - Fax:562-795-5297
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT11464AMedicare ID - Type Unspecified
CAR54602Medicare UPIN