Provider Demographics
NPI:1750339768
Name:YOUNG, IAN AVERY (PT, MS,OCS,SCS)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:AVERY
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PT, MS,OCS,SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RIVER BLUFFS DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-2311
Mailing Address - Country:US
Mailing Address - Phone:540-373-7133
Mailing Address - Fax:540-373-0068
Practice Address - Street 1:3310 FALL HILL AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3000
Practice Address - Country:US
Practice Address - Phone:540-373-7133
Practice Address - Fax:540-373-0068
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050065152251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports