Healthcare Provider Details

I. General information

NPI: 1417991050
Provider Name (Legal Business Name): KEVIN YOUNGS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 E ARLINGTON BLVD
GREENVILLE NC
27858-5868
US

IV. Provider business mailing address

1301 E ARLINGTON BLVD
GREENVILLE NC
27858-5868
US

V. Phone/Fax

Practice location:
  • Phone: 252-565-8812
  • Fax: 252-565-8814
Mailing address:
  • Phone: 252-565-8812
  • Fax: 252-565-8814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9823
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: