Provider Demographics
NPI:1992990154
Name:YOUNG, EVERETT CURTISS (MPT)
Entity type:Individual
Prefix:MR
First Name:EVERETT
Middle Name:CURTISS
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3654 W. ANTHEM WAY
Mailing Address - Street 2:SUITE B102
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086
Mailing Address - Country:US
Mailing Address - Phone:623-551-9706
Mailing Address - Fax:623-551-9708
Practice Address - Street 1:3345 S. VAL VISTA DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85246
Practice Address - Country:US
Practice Address - Phone:480-897-7125
Practice Address - Fax:480-857-8250
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid
AZZ131370Medicare UPIN
AZPENDINGMedicaid