Healthcare Provider Details

I. General information

NPI: 1003341629
Provider Name (Legal Business Name): CASEY YOUNTS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 BROKEN SOUND PKWY SUITE 450
BOCA RATON FL
33487-2773
US

IV. Provider business mailing address

6933 CHARNEL LN
CLIMAX NC
27233-9167
US

V. Phone/Fax

Practice location:
  • Phone: 800-875-8999
  • Fax:
Mailing address:
  • Phone: 336-944-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA5280
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number09463
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: