Active NPI
Jordan Young, LAT, ATC
- Athletic Trainer
- Burlington, VT
National Provider Identifier
1942852652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 104.0133922
- Practice address
- 789 Pine St
Burlington, VT 05401-4933 - Phone
- (802) 264-1052
- NPI assigned
- Jul 12, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 104.0133922 | VT | Primary |
Addresses
Primary practice location
789 Pine St
Burlington, VT 05401-4933
Mailing address
3031 Slack St
West Danville, VT 05873-9734
Phone (802) 535-9643
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104.0133922 | VT | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562889600000",
"number": "1942852652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3031 SLACK ST",
"city": "WEST DANVILLE",
"state": "VT",
"postal_code": "058739734",
"telephone_number": "802-535-9643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "789 PINE ST",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054014933",
"telephone_number": "802-264-1052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "JORDAN",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-07-12",
"last_updated": "2019-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "VT",
"license": "104.0133922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burlington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 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.