Provider Demographics
NPI:1356573331
Name:CHANG, PAUL YANTZI (DPT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:YANTZI
Last Name:CHANG
Suffix:
Gender:M
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:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98231-0120
Mailing Address - Country:US
Mailing Address - Phone:360-332-8167
Mailing Address - Fax:360-332-0931
Practice Address - Street 1:250 G ST
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-4019
Practice Address - Country:US
Practice Address - Phone:360-332-8167
Practice Address - Fax:360-332-0931
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60059028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist