1396705281 NPI number — DR. SHARON B YOUNG PT, DSC

Table of content: DR. SHARON B YOUNG PT, DSC (NPI 1396705281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396705281 NPI number — DR. SHARON B YOUNG PT, DSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
SHARON
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RHODES
Provider Other First Name:
SHARON
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1396705281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 LOCKENBIE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAUPHIN ISLAND
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36528-4438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-404-9502
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6051 AIRPORT BLVD
Provider Second Line Business Practice Location Address:
STE A-1
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-460-0201
Provider Business Practice Location Address Fax Number:
251-460-2848
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PTH1107 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 650016454 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51008986 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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