Provider Demographics
NPI:1598306367
Name:YOUNG, TYLER DOUGLAS (PT, DPT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:DOUGLAS
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BURWELL ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-1794
Mailing Address - Country:US
Mailing Address - Phone:315-823-5360
Mailing Address - Fax:315-823-5321
Practice Address - Street 1:140 BURWELL ST
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NY
Practice Address - Zip Code:13365-1794
Practice Address - Country:US
Practice Address - Phone:315-823-5360
Practice Address - Fax:315-823-5321
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist