Provider Demographics
NPI:1942250261
Name:YOUNG, WILDA MILLER (LPT)
Entity Type:Individual
Prefix:MRS
First Name:WILDA
Middle Name:MILLER
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2009 DALTON RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-5825
Mailing Address - Country:US
Mailing Address - Phone:336-574-1506
Mailing Address - Fax:336-370-1016
Practice Address - Street 1:1313 CAROLINA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6000
Practice Address - Country:US
Practice Address - Phone:336-275-6380
Practice Address - Fax:336-275-6381
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP97661Medicare UPIN
NC2504554AMedicare PIN