MEDICARE: ALEXIS YOUNG PT, DPT, CLT

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	5120	NV

General Provider Information

NPI Number	:	1376325027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS YOUNG PT, DPT, CLT

Provider Business Mailing Address
First Line	:	8545 GLACIER POINT ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-2541
Country	:	US
Telephone Number	:	702-720-0611
Fax Number	:

Provider Business Practice Location Address
First Line	:	8545 GLACIER POINT ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-2541
Country	:	US
Telephone Number	:	702-720-0611
Fax Number	:

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

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	10/17/2023

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