Active NPI
Martin S Young, L.P.T.
- Physical Therapist
- Shreveport, LA
National Provider Identifier
1407854367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT-381
- Practice address
- 241 Ockley Dr
Shreveport, LA 71105-3024 - Phone
- (318) 617-4194
- NPI assigned
- Jul 13, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1040277 | TX | |
| Physical Therapist | 225100000X | PT-381 | LA | Primary |
Addresses
Primary practice location
241 Ockley Dr
Shreveport, LA 71105-3024
Mailing address
241 Ockley Dr
Shreveport, LA 71105-3024
Phone (318) 617-4194
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093213-01 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-381 | LA | MD | Physical Therapist |
| 1040277 | TX | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phynet, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Health Service Clinic/Center
- Gladewater, TX
- NPI 1912174111
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573516800000",
"number": "1407854367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "241 OCKLEY DR",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711053024",
"telephone_number": "318-617-4194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "241 OCKLEY DR",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711053024",
"telephone_number": "318-617-4194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "MARTIN",
"middle_name": "S",
"credential": "L.P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-13",
"last_updated": "2019-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1040277",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "LA",
"license": "PT-381",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1093213-01",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.