Organization
YOUNG 4 LIFE REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATRINA RENISE YOUNG LPTA (OWNER)
(803) 736-1759
Entity
Organization
Contact information
Practice address
528 ARCOLA DR, COLUMBIA, SC 29223-5407
(803) 736-1759
(803) 736-0374
Mailing address
528 ARCOLA DR, COLUMBIA, SC 29223-5407
(803) 736-1759
(803) 736-0374
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1811
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225206196
INDIVIDUAL NPI
SC
Enumeration date
02/14/2008
Last updated
02/14/2008
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