Individual
DEREK ALAN YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1224400
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320496801
—
TX
05
—
320496802
—
TX
01
—
881T55
BCBS
TX
01
—
P01166355
MEDICARE RAILROAD
TX
Enumeration date
08/01/2012
Last updated
12/16/2013
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