Provider Demographics
NPI:1528153038
Name:YOUNG, DENISE BERGERON (PT)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:BERGERON
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PT
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Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:7208 RUSHING WATER COURT
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527
Mailing Address - Country:US
Mailing Address - Phone:251-625-2461
Mailing Address - Fax:
Practice Address - Street 1:3202 OLD SHELL ROAD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607
Practice Address - Country:US
Practice Address - Phone:251-450-0070
Practice Address - Fax:251-450-0072
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALPTH44622251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51527760Medicare UPIN