MEDICARE: MRS. DAWN MICHELLE YOUNG PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	40QAO0743700	NJ

General Provider Information

NPI Number	:	1295006591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAWN MICHELLE YOUNG PT

Provider Business Mailing Address
First Line	:	16 WILLOW DR
Second Line	:
City	:	NEPTUNE
State	:	NJ
Zip	:	07753-3334
Country	:	US
Telephone Number	:	732-918-8162
Fax Number	:

Provider Business Practice Location Address
First Line	:	3349 HIGHWAY 138
Second Line	:	BUILDING B SUITE A
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-9671
Country	:	US
Telephone Number	:	732-280-6050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2012
Last Update Date	:	01/18/2012

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