Provider Demographics
NPI:1487988614
Name:YOUNG, DEANAR ALI (LMP)
Entity type:Individual
Prefix:
First Name:DEANAR
Middle Name:ALI
Last Name:YOUNG
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 W MULLAN AVE UNIT 22
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7115
Mailing Address - Country:US
Mailing Address - Phone:509-850-1009
Mailing Address - Fax:
Practice Address - Street 1:327 W 8TH AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2565
Practice Address - Country:US
Practice Address - Phone:509-624-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60107114225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist