Healthcare Provider Details

I. General information

NPI: 1083527501
Provider Name (Legal Business Name): WILLIAM YOUNGBLOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PEPPERELL PKWY
OPELIKA AL
36801-5452
US

IV. Provider business mailing address

192 POPLAR ST
PRATTVILLE AL
36066-5332
US

V. Phone/Fax

Practice location:
  • Phone: 334-749-3411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA12576
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: