MEDICARE: CHAU PHAN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT27275	CA
2	2251X0800X	Orthopedic Physical Therapist	LPT30026	AZ

General Provider Information

NPI Number	:	1235114141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAU PHAN PT

Provider Business Mailing Address
First Line	:	230 E CIVIC CENTER DR APT 1019
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-0010
Country	:	US
Telephone Number	:	310-430-9791
Fax Number	:

Provider Business Practice Location Address
First Line	:	3336 E CHANDLER HEIGHTS RD STE 126
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85298
Country	:	US
Telephone Number	:	480-840-6125
Fax Number	:	480-840-6122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	06/20/2018

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Directions to “ CHAU PHAN PT” Practice Location

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