Provider Demographics
NPI:1255377628
Name:YOUNG, LAURA JEAN (PT MSPT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JEAN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PT MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GARNETT LN
Mailing Address - Street 2:NORTHERN RI PHYSICAL THERAPY
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1414
Mailing Address - Country:US
Mailing Address - Phone:401-949-0380
Mailing Address - Fax:401-949-5581
Practice Address - Street 1:1 GARNETT LN
Practice Address - Street 2:NORTHERN RI PHYSICAL THERAPY
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1414
Practice Address - Country:US
Practice Address - Phone:401-949-0380
Practice Address - Fax:401-949-5581
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI410188OtherBLUE CHIP
6400145OtherUNITED HEALTH NEW ENGLAND
RI75277OtherBLUE CROSS
659007527Medicare ID - Type Unspecified
6400145OtherUNITED HEALTH NEW ENGLAND