Provider Demographics
NPI:1144727041
Name:YOUNG, MYKEISHA L (DPT)
Entity type:Individual
Prefix:
First Name:MYKEISHA
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-756-3107
Mailing Address - Fax:919-535-3271
Practice Address - Street 1:43490 YUKON DR STE 212
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7326
Practice Address - Country:US
Practice Address - Phone:703-729-7920
Practice Address - Fax:703-729-7923
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26937225100000X
VACP014311T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist