Provider Demographics
NPI:1104458975
Name:YOUNG, CARLY (PT, DPT)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
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 1:126 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1970
Mailing Address - Country:US
Mailing Address - Phone:570-687-1358
Mailing Address - Fax:
Practice Address - Street 1:200 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:EYNON
Practice Address - State:PA
Practice Address - Zip Code:18403-1029
Practice Address - Country:US
Practice Address - Phone:570-291-8563
Practice Address - Fax:570-227-1034
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist