Provider Demographics
NPI:1992196562
Name:YOUNG, LAURA M (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:503 WESTBURY DR STE 3
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2726
Practice Address - Country:US
Practice Address - Phone:319-337-4325
Practice Address - Fax:319-337-0608
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1213Medicare PIN
IAIB3481021Medicare PIN
IAIB1213041Medicare PIN
IAIB3481Medicare PIN