Individual
LISIMBA YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4699
(601) 200-2000
Mailing address
711 LAKE HARBOUR DR APT 1010, RIDGELAND, MS 39157-4305
(662) 590-3993
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
7979
MS
225200000X
Physical Therapy Assistant
CP059935A
NC
Other
Enumeration date
07/28/2026
Last updated
07/28/2026
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