Healthcare Provider Details

I. General information

NPI: 1356573331
Provider Name (Legal Business Name): PAUL YANTZI CHANG DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 G ST
BLAINE WA
98230-4019
US

IV. Provider business mailing address

PO BOX 120
BLAINE WA
98231-0120
US

V. Phone/Fax

Practice location:
  • Phone: 360-332-8167
  • Fax: 360-332-0931
Mailing address:
  • Phone: 360-332-8167
  • Fax: 360-332-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60059028
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: