Provider Demographics
NPI:1760759526
Name:CHANG, CATHERINE PHAM (DPT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:PHAM
Last Name:CHANG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 S KING ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2066
Mailing Address - Country:US
Mailing Address - Phone:808-348-6336
Mailing Address - Fax:808-744-8571
Practice Address - Street 1:1350 S KING ST STE 300
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2066
Practice Address - Country:US
Practice Address - Phone:808-348-6336
Practice Address - Fax:808-744-8571
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 3592225100000X
CAPT 38438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist