Provider Demographics
NPI:1649499674
Name:YOUTKUS, NANCY MELINDA (PT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:MELINDA
Last Name:YOUTKUS
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 1:19744 BEACH BLVD
Mailing Address - Street 2:#403
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2988
Mailing Address - Country:US
Mailing Address - Phone:714-625-6638
Mailing Address - Fax:
Practice Address - Street 1:19744 BEACH BLVD
Practice Address - Street 2:#403
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2988
Practice Address - Country:US
Practice Address - Phone:714-625-6638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18992225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist