Active NPI
Richard Allen Young, PT
- Physical Therapist
- West Melbourne, FL
National Provider Identifier
1669655775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 3511
- Practice address
- 4280 Minton Rd
Suite 120
West Melbourne, FL 32904-9564 - Phone
- (321) 984-2933
- Fax
- (951) 973-7216
- NPI assigned
- Dec 11, 2007
- 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 | PT 3511 | FL | Primary |
| Physical Therapist | 225100000X | PT008709 | GA |
Addresses
Primary practice location
4280 Minton Rd
Suite 120
West Melbourne, FL 32904-9564
Mailing address
4280 Minton Rd
Suite 120
West Melbourne, FL 32904-9564
Phone (321) 984-2933
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT3511 | Other | FL | PT LICENSURE |
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 3511 | FL | MD | Physical Therapist |
| PT008709 | GA | MD | Physical Therapist |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493596800000",
"number": "1669655775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4280 MINTON RD",
"address_2": "SUITE 120",
"city": "WEST MELBOURNE",
"state": "FL",
"postal_code": "329049564",
"telephone_number": "321-984-2933",
"fax_number": "951-973-7216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4280 MINTON RD",
"address_2": "SUITE 120",
"city": "WEST MELBOURNE",
"state": "FL",
"postal_code": "329049564",
"telephone_number": "321-984-2933",
"fax_number": "951-973-7216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "RICHARD",
"middle_name": "ALLEN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-11",
"last_updated": "2017-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT 3511",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT008709",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT LICENSURE",
"identifier": "PT3511",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.