Provider Demographics
NPI:1255955274
Name:YOUNG, DENNIS (LMT)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107-9401
Mailing Address - Country:US
Mailing Address - Phone:513-774-9800
Mailing Address - Fax:888-315-2865
Practice Address - Street 1:11928 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-1789
Practice Address - Country:US
Practice Address - Phone:513-774-9800
Practice Address - Fax:888-315-2865
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.020868225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist