MEDICARE: EVA CHAN PT, DPT

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	052773	NY

General Provider Information

NPI Number	:	1154151579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA CHAN PT, DPT

Provider Business Mailing Address
First Line	:	10 YORKSHIRE RD
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-3612
Country	:	US
Telephone Number	:	718-440-2235
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 OLD SHORE RD
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-2222
Country	:	US
Telephone Number	:	516-464-7959
Fax Number	:

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

Provider Enumeration Date	:	08/02/2024
Last Update Date	:	08/12/2024

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