MEDICARE: DR. JOHN YOUNG MCCREADY DPT

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	28519	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	686675	OTHER		MEDICARE #

General Provider Information

NPI Number	:	1750714416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN YOUNG MCCREADY DPT

Provider Business Mailing Address
First Line	:	102 THOMAS RD STE 501
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-5549
Country	:	US
Telephone Number	:	318-614-8455
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 THOMAS RD STE 501
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-5549
Country	:	US
Telephone Number	:	318-614-8455
Fax Number	:

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

Provider Enumeration Date	:	08/17/2013
Last Update Date	:	04/28/2024

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