Healthcare Provider Details

I. General information

NPI: 1265035331
Provider Name (Legal Business Name): BRENDA YOUNG PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 STOCKDALE HWY STE B1
BAKERSFIELD CA
93311-1004
US

IV. Provider business mailing address

1106 WALNUT ST STE 110
SAN LUIS OBISPO CA
93401-2416
US

V. Phone/Fax

Practice location:
  • Phone: 661-827-8959
  • Fax: 661-827-1779
Mailing address:
  • Phone: 805-788-0805
  • Fax: 805-788-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT298855
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: