Provider Demographics
NPI:1265584676
Name:YOUNG, SETH (PT)
Entity type:Individual
Prefix:MR
First Name:SETH
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2037
Mailing Address - Country:US
Mailing Address - Phone:610-365-8990
Mailing Address - Fax:610-365-8991
Practice Address - Street 1:39 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-2037
Practice Address - Country:US
Practice Address - Phone:610-365-8990
Practice Address - Fax:610-365-8991
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066977Medicare ID - Type Unspecified