Healthcare Provider Details

I. General information

NPI: 1619170248
Provider Name (Legal Business Name): DON ARNOLD YOUNG PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W GRANT ST
MACOMB IL
61455-2867
US

IV. Provider business mailing address

28633 N MANLEY RD
AVON IL
61415-8843
US

V. Phone/Fax

Practice location:
  • Phone: 309-837-2386
  • Fax:
Mailing address:
  • Phone: 309-465-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: