MEDICARE: MR. KEVIN YOUNGS 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	225100000X	Physical Therapist	9823	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	138CP	OTHER	NC	BCBS NC

General Provider Information

NPI Number	:	1417991050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN YOUNGS PT

Provider Business Mailing Address
First Line	:	1301 E ARLINGTON BLVD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5868
Country	:	US
Telephone Number	:	252-565-8812
Fax Number	:	252-565-8814

Provider Business Practice Location Address
First Line	:	1301 E ARLINGTON BLVD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5868
Country	:	US
Telephone Number	:	252-565-8812
Fax Number	:	252-565-8814

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	05/24/2022

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