Healthcare Provider Details

I. General information

NPI: 1891262044
Provider Name (Legal Business Name): LAUREN ELYSE YOUNG DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN ELYSE BUCK DPT

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E MAIN ST
EVANSVILLE WI
53536-1177
US

IV. Provider business mailing address

535 E MAIN ST
EVANSVILLE WI
53536-1177
US

V. Phone/Fax

Practice location:
  • Phone: 773-360-7287
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.024049
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: