Provider Demographics
NPI:1669655775
Name:YOUNG, RICHARD ALLEN (PT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
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 1:4280 MINTON RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-9564
Mailing Address - Country:US
Mailing Address - Phone:321-984-2933
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:4280 MINTON RD
Practice Address - Street 2:SUITE 120
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-9564
Practice Address - Country:US
Practice Address - Phone:321-984-2933
Practice Address - Fax:951-973-7216
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 3511225100000X
GAPT008709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT3511OtherPT LICENSURE