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General NPI Number Information
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NPI Number | 1699568659
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Entity Type | Individual
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Provider Name | MADISON FAYE YOUNG PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 318 N MAIN ST
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City | GRAPEVINE
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State | TX
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Zip | 76051-3323
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Country | US
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Telephone | 817-264-7450
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 BAYWATER DR APT 604
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City | PLANO
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State | TX
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Zip | 75093-5726
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Country | US
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Telephone |
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1406707
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License Number State | TX
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