Basic Information
| Provider Information | |||||||||
| NPI: | 1285725259 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | MEILING | ||||||||
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| Credential: | ATC, PTA, CSCS, MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 RAZOR STRAP RD APT C | ||||||||
| Address2: | |||||||||
| City: | NORTH EAST | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219012726 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 304 NORTH ST # 306 | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219215570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103925550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | A2860 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.