Provider Demographics
NPI:1740913391
Name:YOUNG, DAKOTA (ATC)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 COLLEGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MT. CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:361 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IL
Practice Address - Zip Code:62806-1071
Practice Address - Country:US
Practice Address - Phone:618-599-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960049372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL096004937OtherSTATE