Provider Demographics
NPI:1750798781
Name:YOUNG, DANIEL TAYLOR JR (MED LAT ATC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:TAYLOR
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:MED LAT ATC
Other - Prefix:
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Mailing Address - Street 1:4013 RAMBLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8722
Mailing Address - Country:US
Mailing Address - Phone:803-917-6969
Mailing Address - Fax:
Practice Address - Street 1:7941 OAK ESTATE ST
Practice Address - Street 2:APT. 231
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-1966
Practice Address - Country:US
Practice Address - Phone:803-917-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2015-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19672255A2300X
TN17412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer