Basic Information
| Provider Information | |||||||||
| NPI: | 1780775296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | HOWARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8300 HEALTH PARK | ||||||||
| Address2: | SUITE 127 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276154731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198456160 | ||||||||
| FaxNumber: | 9198456188 | ||||||||
| Practice Location | |||||||||
| Address1: | 8300 HEALTH PARK | ||||||||
| Address2: | SUITE 127 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276154731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198456160 | ||||||||
| FaxNumber: | 9198456188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 05/20/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 7956 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
ID Information
| ID | Type | State | Issuer | Description | 078YP | 01 | NC | BCBS PROVIDER # | OTHER |