Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 035650 | NY |
NPI | 1003150277 |
---|---|
Provider Name | Thomas Chang |
First Address | Whitestone, NY 11357-4142 |
Second Address | Whitestone, NY 11357-4142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2012 |
Last Update Date | 12/11/2012 |