Provider Demographics
NPI:1295502011
Name:FOREVER YOUNG MOBILE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:FOREVER YOUNG MOBILE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:BARNES
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:910-239-7834
Mailing Address - Street 1:1109 JAMES ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-6979
Mailing Address - Country:US
Mailing Address - Phone:910-239-7834
Mailing Address - Fax:
Practice Address - Street 1:2268 LITTLE RIVER NECK RD
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-6265
Practice Address - Country:US
Practice Address - Phone:910-239-7834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty