Healthcare Provider Details

I. General information

NPI: 1386640563
Provider Name (Legal Business Name): MARY CHEN D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 N ORANGE ST
ORANGE CA
92867-6737
US

IV. Provider business mailing address

891 N ORANGE ST
ORANGE CA
92867-6737
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-3887
  • Fax:
Mailing address:
  • Phone: 714-310-9740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT26386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: