MEDICARE: DONNA YOUNG CTRS

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	225800000X	Recreation Therapist	20025

General Provider Information

NPI Number	:	1659565190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA YOUNG CTRS

Provider Business Mailing Address
First Line	:	505 E CAPOVILLA AVE STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4332
Country	:	US
Telephone Number	:	702-260-7329
Fax Number	:	702-896-5638

Provider Business Practice Location Address
First Line	:	505 E CAPOVILLA AVE STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4332
Country	:	US
Telephone Number	:	702-260-7329
Fax Number	:	702-896-5638

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

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	08/28/2007

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Directions to “ DONNA YOUNG CTRS” Practice Location

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