Provider Demographics
NPI:1013533546
Name:CHANG, SAMANTHA EMMA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:EMMA
Last Name:CHANG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 S GOODYEAR BLVD E APT 217
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-4955
Mailing Address - Country:US
Mailing Address - Phone:650-534-4494
Mailing Address - Fax:
Practice Address - Street 1:6320 W UNION HILLS DR STE 2200B
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1375
Practice Address - Country:US
Practice Address - Phone:623-561-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-20
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist