Provider Demographics
NPI:1548089501
Name:YOUNG, JUSTIN D (DPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:D
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 SUMMER DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7538
Mailing Address - Country:US
Mailing Address - Phone:478-390-5105
Mailing Address - Fax:
Practice Address - Street 1:17 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3956
Practice Address - Country:US
Practice Address - Phone:603-577-3050
Practice Address - Fax:603-577-3062
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist