MEDICARE: DAE YOUNG CHEONG PT

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	4974	MN
2	225100000X	Physical Therapist	PT42274	FL
3	225100000X	Physical Therapist	12791	MN

General Provider Information

NPI Number	:	1265171086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAE YOUNG CHEONG PT

Provider Business Mailing Address
First Line	:	21756 STATE ROAD 54 STE 102
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-2905
Country	:	US
Telephone Number	:	813-279-6234
Fax Number	:	888-492-7854

Provider Business Practice Location Address
First Line	:	21756 STATE ROAD 54 STE 102
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-2905
Country	:	US
Telephone Number	:	813-279-6234
Fax Number	:	888-492-7854

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

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	03/04/2026

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Directions to “ DAE YOUNG CHEONG PT” Practice Location

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