Healthcare Provider Details

I. General information

NPI: 1093092397
Provider Name (Legal Business Name): ANDREW SCOTT YOUNG PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1383 STACY DR
CANTON MI
48188-1441
US

IV. Provider business mailing address

1383 STACY DR
CANTON MI
48188-1441
US

V. Phone/Fax

Practice location:
  • Phone: 734-981-1500
  • Fax: 734-981-1515
Mailing address:
  • Phone: 734-981-1500
  • Fax: 734-981-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502003319
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: