Healthcare Provider Details

I. General information

NPI: 1376786426
Provider Name (Legal Business Name): NAVE J YOUNG CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2009
Last Update Date: 04/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S DOUGLAS HWY
GILLETTE WY
82716-4029
US

IV. Provider business mailing address

404 S DOUGLAS HWY
GILLETTE WY
82716-4029
US

V. Phone/Fax

Practice location:
  • Phone: 307-670-3636
  • Fax: 307-686-0768
Mailing address:
  • Phone: 307-670-3636
  • Fax: 307-686-0768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: