Provider Demographics
NPI:1386669828
Name:YOUNG, LISA N (MPT, ATC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:N
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MPT, ATC
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 57
Mailing Address - Street 2:
Mailing Address - City:ALSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03602-0057
Mailing Address - Country:US
Mailing Address - Phone:603-835-7828
Mailing Address - Fax:603-835-7827
Practice Address - Street 1:122 NH ROUTE 12A
Practice Address - Street 2:
Practice Address - City:LANGDON
Practice Address - State:NH
Practice Address - Zip Code:03602-8221
Practice Address - Country:US
Practice Address - Phone:603-835-7828
Practice Address - Fax:603-835-7827
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2994225100000X
NH00362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAA65774OtherHARVARD PILGRIM
NH30394477Medicaid
NHP00339333OtherRAILROAD MEDICARE
NH08Y007675NH03OtherANTHEM BCBS
NH6007380OtherMVP
NHAA65774OtherHARVARD PILGRIM