Provider Demographics
NPI:1770527152
Name:YOUNG, STEPHEN C (PT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:C
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:705 17TH ST STE 402
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3516
Mailing Address - Country:US
Mailing Address - Phone:706-225-2525
Mailing Address - Fax:706-225-7185
Practice Address - Street 1:705 17TH ST STE 402
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3516
Practice Address - Country:US
Practice Address - Phone:706-225-2525
Practice Address - Fax:706-225-7185
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q21812Medicare UPIN
GA65BBDSRMedicare PIN