Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 09463 | OR |
Y | 225200000X | Physical Therapy Assistant | A5280 | NC |
NPI | 1003341629 |
---|---|
Provider Name | Casey Younts |
First Address | Climax, NC 27233-9167 |
Second Address | Boca Raton, FL 33487-2773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2017 |
Last Update Date | 21/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000004319000 | FIRSTCAROLINACARE (01) | NC |