Provider Demographics
NPI:1083935712
Name:YOUNG, JONATHAN R (DPT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 N WINTERSET ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6379
Mailing Address - Country:US
Mailing Address - Phone:316-650-5956
Mailing Address - Fax:
Practice Address - Street 1:822 N ANDOVER RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-9527
Practice Address - Country:US
Practice Address - Phone:316-247-5499
Practice Address - Fax:316-315-5965
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist