Provider Demographics
NPI:1831245083
Name:YOUNG, SUSAN AMY (PT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:AMY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 JUPITER ST
Mailing Address - Street 2:
Mailing Address - City:SHEPPARD AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76311-1011
Mailing Address - Country:US
Mailing Address - Phone:940-855-2201
Mailing Address - Fax:
Practice Address - Street 1:105 JUPITER ST
Practice Address - Street 2:
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311-1011
Practice Address - Country:US
Practice Address - Phone:940-855-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1138451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1138451OtherPHYSICAL THERAPY LICENSE