Provider Demographics
NPI:1619173689
Name:WANG, CHARNG-SHEN (PT, AP)
Entity Type:Individual
Prefix:DR
First Name:CHARNG-SHEN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:PT, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 S VOLUSIA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-9134
Mailing Address - Country:US
Mailing Address - Phone:386-774-6333
Mailing Address - Fax:386-410-1603
Practice Address - Street 1:2501 S VOLUSIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-9134
Practice Address - Country:US
Practice Address - Phone:386-774-6333
Practice Address - Fax:386-410-1603
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP544171100000X
FLPT7339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1870210OtherMAILHANDLERS #
FLC0582OtherBCBS ACU #
FL162582100OtherUS DEPT OF LABOR #
FL593586094OtherTAX ID #
FLY923DOtherBCBS FACILITY OC
FLY923LOtherBCBS FACILITY PO
FLY926BOtherBCBS FACILITY OB
FLY7522OtherBCBS PT # DOC
FLK1325OtherMEDICARE
FL3118880OtherAETNA # DOC
FL63701045OtherCHAMPUS #