Provider Demographics
NPI:1316608813
Name:CHANG, GRACE WING-YOUNG (PT, DPT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:WING-YOUNG
Last Name:CHANG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ELIZABETH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4803
Mailing Address - Country:US
Mailing Address - Phone:212-625-2528
Mailing Address - Fax:212-937-2015
Practice Address - Street 1:17 ELIZABETH ST STE 303
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4803
Practice Address - Country:US
Practice Address - Phone:212-625-2528
Practice Address - Fax:212-937-2015
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist