Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT019300 | PA |
NPI | 1003076118 |
---|---|
Provider Name | Mr. Jonathan Keith Young |
First Address | Wexford, PA 15090-9260 |
Second Address | Pittsburgh, PA 15241-3921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2008 |
Last Update Date | 21/08/2008 |