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General NPI Number Information
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NPI Number | 1124374657
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Entity Type | Individual
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Provider Name | DIANA LYNN YOUNG PTA
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Gender | Female
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 4415 RIO D ORO
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City | SAN ANTONIO
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State | TX
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Zip | 78233-6748
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Country | US
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Telephone | 210-248-9706
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Fax | 210-257-0268
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Provider Business Mailing Address
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Address Line | 937 SCHERTZ PKWY
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City | SCHERTZ
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State | TX
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Zip | 78154-1629
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Country | US
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Telephone | 469-334-7470
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2003323
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License Number State | TX
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