Provider Demographics
NPI:1457312514
Name:YOUNG, JOANNE (PT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8022 STATE ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304-2512
Mailing Address - Country:US
Mailing Address - Phone:315-896-5100
Mailing Address - Fax:315-896-5102
Practice Address - Street 1:8022 STATE ROUTE 12
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:NY
Practice Address - Zip Code:13304-2512
Practice Address - Country:US
Practice Address - Phone:315-896-5100
Practice Address - Fax:315-896-5102
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400002713Medicare PIN