Individual
KENNETH EUGENE YOUNGBLOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
136 WEST DYKES STREET, COCHRAN, GA 31014
(478) 934-8801
(229) 868-2175
Mailing address
174 SOUTH 8TH STREET, COCHRAN, GA 31014
(478) 934-4013
(229) 868-2175
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1457
GA
Other
Enumeration date
05/21/2007
Last updated
07/08/2007
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