Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1113645 | TX |
NPI | 1043311905 |
---|---|
Provider Name | Jennifer Read Young |
First Address | Austin, TX 78750-3819 |
Second Address | Austin, TX 78750-3819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
659667 | BCBS PROVIDER NUMBER (01) | TX |