=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992990154
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVERETT CURTISS YOUNG MPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2007
-----------------------------------------------------
Last Update Date | 09/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3345 S. VAL VISTA DR
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-897-7125
-----------------------------------------------------
Fax | 480-857-8250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3654 W. ANTHEM WAY SUITE B102
-----------------------------------------------------
City | ANTHEM
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-551-9706
-----------------------------------------------------
Fax | 623-551-9708
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 7812
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------