Provider Demographics
NPI:1750694899
Name:CHANG, PETER (PT, DPT)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
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 1:1700 WILLOW LAWN DR
Mailing Address - Street 2:STE 230
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3003
Mailing Address - Country:US
Mailing Address - Phone:804-340-1193
Mailing Address - Fax:804-340-1930
Practice Address - Street 1:1700 WILLOW LAWN DR
Practice Address - Street 2:STE 230
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3003
Practice Address - Country:US
Practice Address - Phone:804-340-1193
Practice Address - Fax:804-340-1930
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1750694899Medicaid
VA365769OtherBCBS (PHYSICAL THERAPY)
VAP00871014OtherMEDICARE RAILROAD
VA9492613OtherAETNA
VAVAA102295Medicare PIN
VAC05954Medicare PIN