=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265838528
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COLLEEN H YOUNG LMT, CLT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2014
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 CORPORATE DRIVE SUITE 3
-----------------------------------------------------
City | CLIFTON PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-663-6000
-----------------------------------------------------
Fax | 518-665-3517
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 CORPORATE DRIVE SUITE 3
-----------------------------------------------------
City | CLIFTON PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-663-6000
-----------------------------------------------------
Fax | 518-665-3517
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 027147
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------