Provider Demographics
NPI:1538419387
Name:CHANG, FENGTZU (MSPT)
Entity type:Individual
Prefix:
First Name:FENGTZU
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 AGASSIZ ST
Mailing Address - Street 2:APT 5
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2849
Mailing Address - Country:US
Mailing Address - Phone:617-460-5488
Mailing Address - Fax:
Practice Address - Street 1:1955 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1405
Practice Address - Country:US
Practice Address - Phone:617-460-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist