Healthcare Provider Details

I. General information

NPI: 1780775296
Provider Name (Legal Business Name): BRENT HOWARD YOUNG PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HORIZON DR STE 115
RALEIGH NC
27615-4947
US

IV. Provider business mailing address

200 HORIZON DR STE 115
RALEIGH NC
27615-4947
US

V. Phone/Fax

Practice location:
  • Phone: 919-875-1932
  • Fax: 919-875-1933
Mailing address:
  • Phone: 919-875-1932
  • Fax: 919-875-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number7956
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: