Provider Demographics
NPI:1184735912
Name:YOUNGMAN, PETE (ATC)
Entity type:Individual
Prefix:MR
First Name:PETE
Middle Name:
Last Name:YOUNGMAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2579 CAMPDEN WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3906
Mailing Address - Country:US
Mailing Address - Phone:916-564-9627
Mailing Address - Fax:
Practice Address - Street 1:1 SPORTS PKWY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2300
Practice Address - Country:US
Practice Address - Phone:916-286-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer