Healthcare Provider Details

I. General information

NPI: 1528153038
Provider Name (Legal Business Name): DENISE BERGERON YOUNG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 OLD SHELL ROAD
MOBILE AL
36607
US

IV. Provider business mailing address

7208 RUSHING WATER COURT
SPANISH FORT AL
36527
US

V. Phone/Fax

Practice location:
  • Phone: 251-450-0070
  • Fax: 251-450-0072
Mailing address:
  • Phone: 251-625-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTH4462
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: