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NPI Code Detail

MEDICARE: KENNETH YOUNG

MEDICARE: KENNETH YOUNG
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
1225100000XPhysical Therapist1265309TX

General Provider Information

NPI Number : 1689041287
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH YOUNG
Provider Business Mailing Address
First Line : 3838 50TH ST
Second Line :
City : LUBBOCK
State : TX
Zip : 79413-3808
Country : US
Telephone Number : 806-792-5522
Fax Number : 806-785-7582
Provider Business Practice Location Address
First Line : 3838 50TH ST
Second Line :
City : LUBBOCK
State : TX
Zip : 79413-3808
Country : US
Telephone Number : 806-792-5522
Fax Number : 806-785-7582
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2015
Last Update Date : 08/31/2015

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Directions to “ KENNETH YOUNG ” Practice Location

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