Provider Demographics
NPI:1265822613
Name:CHANG, PEI-YUAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:PEI-YUAN
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E EGNOR DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9500
Mailing Address - Country:US
Mailing Address - Phone:609-402-1796
Mailing Address - Fax:
Practice Address - Street 1:201 E EGNOR DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9500
Practice Address - Country:US
Practice Address - Phone:609-402-1796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01477700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist