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General NPI Number Information
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NPI Number | 1629518428
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Entity Type | Individual
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Provider Name | JENNIFER L YOUNG PT
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Gender | Female
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 12822 DEL CORSO LOOP
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City | BRADENTON
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State | FL
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Zip | 34211-8434
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Country | US
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Telephone | 541-292-8015
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Fax | 941-343-9402
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Provider Business Mailing Address
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Address Line | 12822 DEL CORSO LOOP
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City | BRADENTON
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State | FL
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Zip | 34211-8434
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Country | US
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Telephone | 541-292-8015
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Fax | 941-343-9402
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT31922
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 03797
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License Number State | OR
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