Provider Demographics
NPI:1093053183
Name:FANG, SHIN-CHIAO (DPT)
Entity Type:Individual
Prefix:
First Name:SHIN-CHIAO
Middle Name:
Last Name:FANG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:1051 EMIL PL
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6451
Mailing Address - Country:US
Mailing Address - Phone:501-733-7656
Mailing Address - Fax:
Practice Address - Street 1:1051 EMIL PL
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6451
Practice Address - Country:US
Practice Address - Phone:501-733-7656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60317375225100000X
TX1250990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist