Basic Information
| Provider Information | |||||||||
| NPI: | 1629250188 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SWIDERSKI | ||||||||
| OtherFirstName: | PATRICIA | ||||||||
| OtherMiddleName: | D | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4255 NORTHFIELD RD | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND HILLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441282811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162929700 | ||||||||
| FaxNumber: | 2163784613 | ||||||||
| Practice Location | |||||||||
| Address1: | 4255 NORTHFIELD RD | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND HILLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441282811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162929700 | ||||||||
| FaxNumber: | 2163784613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2007 | ||||||||
| LastUpdateDate: | 11/27/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT.011249.1YR | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.