Provider Demographics
NPI:1437671609
Name:CHANG, EUNJU (PT DPT)
Entity Type:Individual
Prefix:
First Name:EUNJU
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 RILEY RUN CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-6718
Mailing Address - Country:US
Mailing Address - Phone:914-727-7868
Mailing Address - Fax:
Practice Address - Street 1:450 MAMARONECK AVE STE 412
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-2430
Practice Address - Country:US
Practice Address - Phone:914-686-3116
Practice Address - Fax:914-686-3082
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0165532251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics