Provider Demographics
NPI:1720472418
Name:YOUNG, EMILY (ATC, LAT, MED)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:ATC, LAT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8821 HIGHLAND ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-8113
Mailing Address - Country:US
Mailing Address - Phone:573-268-3414
Mailing Address - Fax:817-847-9308
Practice Address - Street 1:800 N BLUE MOUND RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76131-1052
Practice Address - Country:US
Practice Address - Phone:817-306-0914
Practice Address - Fax:817-847-9308
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT5170207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine