Basic Information
| Provider Information | |||||||||
| NPI: | 1487708160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13A MAIN ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | SPARTA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078711941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737267400 | ||||||||
| FaxNumber: | 9737267440 | ||||||||
| Practice Location | |||||||||
| Address1: | 13A MAIN ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | SPARTA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078711941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737267400 | ||||||||
| FaxNumber: | 9737267440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 05/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA1234300 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.