Provider Demographics
NPI:1770545113
Name:YOUNGER, GUSTAVE WALTER III (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:GUSTAVE
Middle Name:WALTER
Last Name:YOUNGER
Suffix:III
Gender:M
Credentials:ATC, LAT
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Mailing Address - Street 1:STEPHEN F. AUSTIN STATE UNIVERSITY
Mailing Address - Street 2:P.O. BOX 13010 SFA STATION
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75962-0001
Mailing Address - Country:US
Mailing Address - Phone:936-468-4550
Mailing Address - Fax:936-468-4052
Practice Address - Street 1:STEPHEN F. AUSTIN STATE UNIVERSITY
Practice Address - Street 2:HOMER BRYCE STADIUM FIELD HOUSE
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75962-0001
Practice Address - Country:US
Practice Address - Phone:936-468-4550
Practice Address - Fax:936-468-4052
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAT30622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer