Provider Demographics
NPI:1528808334
Name:YOUNG, NICHOLAS GREGG (PT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:GREGG
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 HIDDEN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-4697
Mailing Address - Country:US
Mailing Address - Phone:432-266-8571
Mailing Address - Fax:
Practice Address - Street 1:1513 HIDDEN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-4697
Practice Address - Country:US
Practice Address - Phone:432-266-8571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2677225100000X
TX1390204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist