Healthcare Provider Details

I. General information

NPI: 1043383300
Provider Name (Legal Business Name): DANIEL RAY YOUNG II PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 HIGHWAY 16 E
CARTHAGE MS
39051-4220
US

IV. Provider business mailing address

1555 HWY 35 SOUTH
CARTHAGE MS
39051-6059
US

V. Phone/Fax

Practice location:
  • Phone: 601-267-3241
  • Fax: 601-267-0209
Mailing address:
  • Phone: 601-267-7867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2373
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: