Provider Demographics
NPI:1487694667
Name:CHAN, NANCY (PT)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 SAN ANTONIO RD STE 3
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4624
Mailing Address - Country:US
Mailing Address - Phone:650-494-0991
Mailing Address - Fax:650-494-0129
Practice Address - Street 1:744 SAN ANTONIO RD STE 3
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-4624
Practice Address - Country:US
Practice Address - Phone:650-494-0991
Practice Address - Fax:650-494-0129
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PW00PT88250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABA153OtherMEDICARE PTAN