Healthcare Provider Details

I. General information

NPI: 1477121499
Provider Name (Legal Business Name): EXPANSE ACUPUNCTURE & PHYSICAL THERAPY WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 CATON AVE APT 4A
BROOKLYN NY
11226-2586
US

IV. Provider business mailing address

2233 CATON AVE APT 4A
BROOKLYN NY
11226-2586
US

V. Phone/Fax

Practice location:
  • Phone: 646-926-2848
  • Fax:
Mailing address:
  • Phone: 818-373-9014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: WENDY CHAN
Title or Position: ACUPUNCTURIST & PHYSICAL THERAPIST
Credential: DPT, LAC, DIPL OM
Phone: 646-926-2848