Provider Demographics
NPI:1205562345
Name:PYON, MICHAEL YOUNG (PTA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:YOUNG
Last Name:PYON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 PRESTON RD APT 1525
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2525
Mailing Address - Country:US
Mailing Address - Phone:817-879-9001
Mailing Address - Fax:
Practice Address - Street 1:1701 ELDORADO PKWY STE 202
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-8069
Practice Address - Country:US
Practice Address - Phone:469-257-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2145887225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant