Healthcare Provider Details

I. General information

NPI: 1255909800
Provider Name (Legal Business Name): RICHARD A YOUNG DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICK YOUNG

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 N NORTHWOOD CENTER CT STE 101
COEUR D ALENE ID
83814-6190
US

IV. Provider business mailing address

7319 16TH AVE SW
SEATTLE WA
98106-1836
US

V. Phone/Fax

Practice location:
  • Phone: 208-215-2450
  • Fax: 208-773-1473
Mailing address:
  • Phone: 208-651-6225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number61173797
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: