Provider Demographics
NPI:1801262472
Name:YOUNG, SHAWNA (PTA)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28625 170TH ST
Mailing Address - Street 2:
Mailing Address - City:STOCKPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52651-8054
Mailing Address - Country:US
Mailing Address - Phone:319-796-4490
Mailing Address - Fax:
Practice Address - Street 1:28625 170TH ST
Practice Address - Street 2:
Practice Address - City:STOCKPORT
Practice Address - State:IA
Practice Address - Zip Code:52651-8054
Practice Address - Country:US
Practice Address - Phone:319-796-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00969225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant