Provider Demographics
NPI:1538185566
Name:YOUNG, RUTH JEANNETTE (PT)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:JEANNETTE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 CARMEL RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3120
Mailing Address - Country:US
Mailing Address - Phone:336-282-6222
Mailing Address - Fax:336-282-5723
Practice Address - Street 1:1802 CARMEL RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-3120
Practice Address - Country:US
Practice Address - Phone:336-282-6222
Practice Address - Fax:336-282-5723
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1026XOtherBLUE CROSS BLUE SHIELD
NC7210201Medicaid