Healthcare Provider Details

I. General information

NPI: 1164337168
Provider Name (Legal Business Name): ETHAN BRADY YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HARVARD ST
CONCORD NH
03301-2318
US

IV. Provider business mailing address

8 HARVARD ST
CONCORD NH
03301-2318
US

V. Phone/Fax

Practice location:
  • Phone: 603-455-6160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: