Provider Demographics
NPI:1184723579
Name:DENISE M YOUNGMAN
Entity type:Organization
Organization Name:DENISE M YOUNGMAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-528-2590
Mailing Address - Street 1:1072 LOS OSOS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3237
Mailing Address - Country:US
Mailing Address - Phone:805-528-2590
Mailing Address - Fax:805-528-2590
Practice Address - Street 1:1072 LOS OSOS VALLEY RD
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3237
Practice Address - Country:US
Practice Address - Phone:805-528-2590
Practice Address - Fax:805-528-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty