MEDICARE: DR. GLORIA JEAN YOUNG PT

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	171W00000X	Contractor	PT10019	FL

General Provider Information

NPI Number	:	1588875488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLORIA JEAN YOUNG PT

Provider Business Mailing Address
First Line	:	PO BOX 77148
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32226-7148
Country	:	US
Telephone Number	:	205-567-4196
Fax Number	:	904-619-5622

Provider Business Practice Location Address
First Line	:	4501 CAPPER RD. #A212
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-7148
Country	:	US
Telephone Number	:	205-567-4196
Fax Number	:	904-619-5622

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. GLORIA JEAN YOUNG PT” Practice Location

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