Provider Demographics
NPI:1629223482
Name:DY, SHARLENE MAE CHAN (PT)
Entity Type:Individual
Prefix:MS
First Name:SHARLENE MAE
Middle Name:CHAN
Last Name:DY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 PONDEROSA LN
Mailing Address - Street 2:APARTMENT 4
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3523
Mailing Address - Country:US
Mailing Address - Phone:706-659-4263
Mailing Address - Fax:
Practice Address - Street 1:1013 RIVERBURCH PKWY
Practice Address - Street 2:SUITE 4
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8887
Practice Address - Country:US
Practice Address - Phone:866-261-8090
Practice Address - Fax:706-226-7869
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008544225100000X
FLPT24159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist