Provider Demographics
NPI:1902298847
Name:FENG, CHAO (LMT)
Entity Type:Individual
Prefix:DR
First Name:CHAO
Middle Name:
Last Name:FENG
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:DR
Other - First Name:FRANK
Other - Middle Name:
Other - Last Name:FENG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:534 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2810
Mailing Address - Country:US
Mailing Address - Phone:860-852-3436
Mailing Address - Fax:
Practice Address - Street 1:534 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-2810
Practice Address - Country:US
Practice Address - Phone:860-852-3436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006522225700000X
DC1395225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist