Healthcare Provider Details

I. General information

NPI: 1639100563
Provider Name (Legal Business Name): CHRISTOPHER K YOUNG MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 E RAY RD SUITE 104
GILBERT AZ
85296-4429
US

IV. Provider business mailing address

1716 E MORELOS ST
CHANDLER AZ
85225-2245
US

V. Phone/Fax

Practice location:
  • Phone: 480-855-5542
  • Fax: 480-855-5756
Mailing address:
  • Phone: 480-703-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6103
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: