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General NPI Number Information
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NPI Number | 1073540639
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Entity Type | Individual
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Provider Name | SCOTT MICHAEL YOUNG ATC/LAT
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 711 W 11TH AVE
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City | PINE BLUFF
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State | AR
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Zip | 71601-4850
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Country | US
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Telephone | 870-543-4293
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Fax |
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Provider Business Mailing Address
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Address Line | 6824 NEVINS RD
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City | PINE BLUFF
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State | AR
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Zip | 71603-8508
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Country | US
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Telephone | 870-550-8886
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT106
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License Number State | AR
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