Healthcare Provider Details

I. General information

NPI: 1255176772
Provider Name (Legal Business Name): TYLER YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 SCHOENERSVILLE RD
BETHLEHEM PA
18018-1864
US

IV. Provider business mailing address

605 SE MAYNARD RD
CARY NC
27511-5717
US

V. Phone/Fax

Practice location:
  • Phone: 610-625-7210
  • Fax:
Mailing address:
  • Phone: 919-745-0838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: