Provider Demographics
NPI:1891789830
Name:YOUNT, STACI (PT, MS, OCS)
Entity Type:Individual
Prefix:MRS
First Name:STACI
Middle Name:
Last Name:YOUNT
Suffix:
Gender:F
Credentials:PT, MS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7600 BURNET RD STE 560
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1273
Practice Address - Country:US
Practice Address - Phone:512-458-1183
Practice Address - Fax:512-458-9433
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11401922251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
650025003OtherRR MC
TX8543250OtherAETNA
TX86330TOtherBCBS
0072920OtherBLUELINK
TX8543250OtherAETNA
TX86330TOtherBCBS
P53854Medicare UPIN
TX8K6822Medicare PIN
0072920OtherBLUELINK