Provider Demographics
NPI:1528651791
Name:YOUNG, SHANAE ONIKA (PT)
Entity type:Individual
Prefix:
First Name:SHANAE
Middle Name:ONIKA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 BIGELOW ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-2521
Mailing Address - Country:US
Mailing Address - Phone:614-404-7824
Mailing Address - Fax:
Practice Address - Street 1:4580 STEPHENS CIR NW STE 301
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3646
Practice Address - Country:US
Practice Address - Phone:330-966-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist