MEDICARE: MS. LAURA JEAN YOUNG PT MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT01753	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410188	OTHER	RI	BLUE CHIP
2	6400145	OTHER		UNITED HEALTH NEW ENGLAND
3	75277	OTHER	RI	BLUE CROSS

General Provider Information

NPI Number	:	1255377628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA JEAN YOUNG PT MSPT

Provider Business Mailing Address
First Line	:	1 GARNETT LN
Second Line	:	NORTHERN RI PHYSICAL THERAPY
City	:	GREENVILLE
State	:	RI
Zip	:	02828-1414
Country	:	US
Telephone Number	:	401-949-0380
Fax Number	:	401-949-5581

Provider Business Practice Location Address
First Line	:	1 GARNETT LN
Second Line	:	NORTHERN RI PHYSICAL THERAPY
City	:	GREENVILLE
State	:	RI
Zip	:	02828-1414
Country	:	US
Telephone Number	:	401-949-0380
Fax Number	:	401-949-5581

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	10/19/2011

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