MEDICARE: RICHARD YOUNG

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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1619466901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD YOUNG

Provider Business Mailing Address
First Line	:	3637 12TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-2703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 E 50TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55417-1337
Country	:	US
Telephone Number	:	612-590-1443
Fax Number	:

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

Provider Enumeration Date	:	05/02/2018
Last Update Date	:	05/02/2018

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Directions to “ RICHARD YOUNG ” Practice Location

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