Healthcare Provider Details

I. General information

NPI: 1457092900
Provider Name (Legal Business Name): MARK YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 ALLEQUIPPA
PITTSBURGH PA
15240
US

IV. Provider business mailing address

622 FORT COUCH RD
PITTSBURGH PA
15241-2070
US

V. Phone/Fax

Practice location:
  • Phone: 419-357-4708
  • Fax:
Mailing address:
  • Phone: 419-357-4708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: