Healthcare Provider Details

I. General information

NPI: 1972192086
Provider Name (Legal Business Name): SYDNEY RHEECE YOUNG ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 FARMERS PASSAGE LOOP
LORIS SC
29569-5672
US

IV. Provider business mailing address

890 FARMERS PASSAGE LOOP
LORIS SC
29569-5672
US

V. Phone/Fax

Practice location:
  • Phone: 609-472-0018
  • Fax:
Mailing address:
  • Phone: 609-472-0018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATH1622
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-6069
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: