Provider Demographics
NPI:1891983516
Name:YOUNG, DEMETRIA S (PTA)
Entity Type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:S
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8411 HAVERSHAM
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2455
Mailing Address - Country:US
Mailing Address - Phone:210-680-3224
Mailing Address - Fax:
Practice Address - Street 1:8411 HAVERSHAM
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-2455
Practice Address - Country:US
Practice Address - Phone:210-680-3224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant