Provider Demographics
NPI:1265964316
Name:YOUNG, JOSEPH ALEXANDER (CPO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALEXANDER
Last Name:YOUNG
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12777 N ROCKWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2710
Mailing Address - Country:US
Mailing Address - Phone:405-717-4199
Mailing Address - Fax:405-717-4717
Practice Address - Street 1:12777 N ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2710
Practice Address - Country:US
Practice Address - Phone:405-717-4199
Practice Address - Fax:405-717-4717
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK72222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist