Provider Demographics
NPI:1588951123
Name:YOUNG, JASON COOPER (PT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:COOPER
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 1:111 SARATOGA AVE
Mailing Address - Street 2:APT. #2113
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-7339
Mailing Address - Country:US
Mailing Address - Phone:973-222-2122
Mailing Address - Fax:
Practice Address - Street 1:111 SARATOGA AVE
Practice Address - Street 2:APT. #2113
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-7339
Practice Address - Country:US
Practice Address - Phone:973-222-2122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2011-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 37241225100000X
NJ40QA01062600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist