Provider Demographics
NPI:1659899292
Name:CHANEY, DYAN (DPT, MPT)
Entity Type:Individual
Prefix:
First Name:DYAN
Middle Name:
Last Name:CHANEY
Suffix:
Gender:F
Credentials:DPT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 NE 56TH CT APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2707
Mailing Address - Country:US
Mailing Address - Phone:954-815-3926
Mailing Address - Fax:954-306-8013
Practice Address - Street 1:2655 E OAKLAND PARK BLVD STE 3
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1608
Practice Address - Country:US
Practice Address - Phone:954-472-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist