Provider Demographics
NPI:1457223646
Name:DEYOUNG, BETTYLOU (PT, DPT)
Entity type:Individual
Prefix:
First Name:BETTYLOU
Middle Name:
Last Name:DEYOUNG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21229 VICTORIAN LN
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-8276
Mailing Address - Country:US
Mailing Address - Phone:951-285-3131
Mailing Address - Fax:
Practice Address - Street 1:39400 MURRIETA HOT SPRINGS RD STE 122A
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-7709
Practice Address - Country:US
Practice Address - Phone:951-285-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA303485OtherLICENSE