Provider Demographics
NPI:1932611274
Name:CHANG, BECKY ANN (PT, DPT)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:ANN
Last Name:CHANG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:ANN
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HSIEH
Mailing Address - Street 1:3252 WATERMARKE PL
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-5616
Mailing Address - Country:US
Mailing Address - Phone:562-508-2970
Mailing Address - Fax:
Practice Address - Street 1:4482 BARRANCA PKWY STE 195
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4706
Practice Address - Country:US
Practice Address - Phone:949-679-3337
Practice Address - Fax:949-679-3336
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist