Provider Demographics
NPI:1801454806
Name:YOUNG, JUSTIN R (DPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7404 MINERAL POINT RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1710
Mailing Address - Country:US
Mailing Address - Phone:608-709-7511
Mailing Address - Fax:608-709-2785
Practice Address - Street 1:7404 MINERAL POINT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1710
Practice Address - Country:US
Practice Address - Phone:608-709-7511
Practice Address - Fax:608-709-2785
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16692-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist