Healthcare Provider Details

I. General information

NPI: 1174555841
Provider Name (Legal Business Name): GINGER MICHELLE YOUNG P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6513 W HEARTH FALLS DR
ROGERS AR
72758-4182
US

IV. Provider business mailing address

3232 N NORTHHILLS BLVD
FAYETTEVILLE AR
72703-4005
US

V. Phone/Fax

Practice location:
  • Phone: 479-763-5113
  • Fax: 479-587-1366
Mailing address:
  • Phone: 479-587-1700
  • Fax: 479-587-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1145910
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1145910
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3065
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: