Provider Demographics
NPI:1942280979
Name:YOUNG, STEPHEN MOSS (MPT OCS)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:MOSS
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MPT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 69
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651
Mailing Address - Country:US
Mailing Address - Phone:304-872-7498
Mailing Address - Fax:304-872-8144
Practice Address - Street 1:207 MERCHANTS WALK
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651
Practice Address - Country:US
Practice Address - Phone:304-872-7498
Practice Address - Fax:304-872-8144
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7305025001Medicaid
WVY04031534Medicare ID - Type Unspecified
P13034Medicare UPIN