Provider Demographics
NPI:1205137866
Name:CHANG, YEONG (LMT, RYT)
Entity type:Individual
Prefix:MS
First Name:YEONG
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:LMT, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 741
Mailing Address - Street 2:
Mailing Address - City:FISKDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01518-0741
Mailing Address - Country:US
Mailing Address - Phone:508-868-8940
Mailing Address - Fax:
Practice Address - Street 1:171 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:N BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01535-1473
Practice Address - Country:US
Practice Address - Phone:508-868-8940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1451172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist