Provider Demographics
NPI:1902015779
Name:YOUNG, TREDENIA (PTA)
Entity Type:Individual
Prefix:MS
First Name:TREDENIA
Middle Name:
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 1:2742 N LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-8408
Mailing Address - Country:US
Mailing Address - Phone:901-487-6290
Mailing Address - Fax:901-375-9949
Practice Address - Street 1:5830 MOUNT MORIAH RD
Practice Address - Street 2:SUITE 6
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-1607
Practice Address - Country:US
Practice Address - Phone:901-375-9855
Practice Address - Fax:901-375-9855
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000063225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant