Connie Chang, PT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

28017 Issued in CA

Practice address

555 W Hacienda Ave
#105
Campbell, CA 95008-6546

Phone

(408) 466-4951

NPI assigned

Apr 12, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Connie Ideta Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302566400000",
    "number": "1508156415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 W HACIENDA AVE",
            "address_2": "#105",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950086546",
            "telephone_number": "408-466-4951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 W HACIENDA AVE",
            "address_2": "#105",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950086546",
            "telephone_number": "408-466-4951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "CONNIE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-12",
        "last_updated": "2011-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "28017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CONNIE",
            "last_name": "IDETA",
            "credential": "PT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kim Chan
• Nancy Chan
• Priscilla Chan
• Albert Tailon Chang, O.D.
• Camila Eva Chang
• Jamie Chang
• Kenneth G Chang, DO
• Wells Yu-Chien Chang
• Chih Chao, L.AC.
• Timothy Chapman

• Orthopedic Physical Therapist in Campbell, CA
• Providers in Campbell, CA by specialty
• Orthopedic Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.