Provider Demographics
NPI:1891879698
Name:YOUNG, WILLIAM III (MSPT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:YOUNG
Suffix:III
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10171A CHUMSTICK HWY
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-9267
Mailing Address - Country:US
Mailing Address - Phone:509-548-3133
Mailing Address - Fax:509-548-5356
Practice Address - Street 1:10171A CHUMSTICK HWY
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-9267
Practice Address - Country:US
Practice Address - Phone:509-548-3133
Practice Address - Fax:509-548-5356
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8336364Medicaid
WAGAB38042Medicare PIN