MEDICARE: MRS. STACI YOUNT PT, MS, OCS

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	2251X0800X	Orthopedic Physical Therapist	1140192	TX
2	225100000X	Physical Therapist	1140192	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	650025003	OTHER		RR MC
2	8543250	OTHER	TX	AETNA
3	86330T	OTHER	TX	BCBS
4	0072920	OTHER		BLUELINK

General Provider Information

NPI Number	:	1891789830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACI YOUNT PT, MS, OCS

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7600 BURNET RD STE 560
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-1273
Country	:	US
Telephone Number	:	512-458-1183
Fax Number	:	512-458-9433

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	03/07/2024

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