Provider Demographics
NPI:1730997503
Name:YOUNG, COLTON (PT, DPT)
Entity type:Individual
Prefix:
First Name:COLTON
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
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:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:RUNNING SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92382-0397
Mailing Address - Country:US
Mailing Address - Phone:909-265-5713
Mailing Address - Fax:
Practice Address - Street 1:29099 HOSPITAL ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352
Practice Address - Country:US
Practice Address - Phone:909-337-0844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307224208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation