Healthcare Provider Details

I. General information

NPI: 1720913981
Provider Name (Legal Business Name): NICKOLAS YOUNG DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12493 UNIVERSITY AVE
CLIVE IA
50325-8286
US

IV. Provider business mailing address

PO BOX 674721
DALLAS TX
75267-4721
US

V. Phone/Fax

Practice location:
  • Phone: 515-358-9494
  • Fax: 515-358-9491
Mailing address:
  • Phone: 515-643-2519
  • Fax: 515-358-9491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004984
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: