Provider Demographics
NPI:1720554983
Name:TAN, SHAY TING DAPHNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHAY TING
Middle Name:DAPHNE
Last Name:TAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DAPHNE
Other - Middle Name:SHAY TING
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3754 MERCURY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 VISTA AVE STE 103
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3699
Practice Address - Country:US
Practice Address - Phone:626-365-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist