MEDICARE: DYAN CHANEY DPT, MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT14768	FL

General Provider Information

NPI Number	:	1659899292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYAN CHANEY DPT, MPT

Provider Business Mailing Address
First Line	:	2700 NE 56TH CT APT 2
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-2707
Country	:	US
Telephone Number	:	954-815-3926
Fax Number	:	954-306-8013

Provider Business Practice Location Address
First Line	:	2655 E OAKLAND PARK BLVD STE 3
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1608
Country	:	US
Telephone Number	:	954-472-7526
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	09/05/2017

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