MEDICARE: EVELYN CHAN

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	172M00000X	Mechanotherapist	MA65852	FL

General Provider Information

NPI Number	:	1750787925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN CHAN

Provider Business Mailing Address
First Line	:	2040 NE 49TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4524
Country	:	US
Telephone Number	:	954-909-9065
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 NE 49TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4524
Country	:	US
Telephone Number	:	954-909-9065
Fax Number	:

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

Provider Enumeration Date	:	11/14/2014
Last Update Date	:	11/14/2014

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Directions to “ EVELYN CHAN ” Practice Location

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