Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 05003264A | IN |
NPI | 1003238775 |
---|---|
Provider Name | Ms. Bethany Youngblood |
First Address | Evansville, IN 47719-0890 |
Second Address | Princeton, IN 47670-9570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2014 |
Last Update Date | 14/01/2014 |