Healthcare Provider Details

I. General information

NPI: 1942355250
Provider Name (Legal Business Name): JOSEPH CHAN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 PACIFIC CONCOURSE DR # 110
LOS ANGELES CA
90045-6200
US

IV. Provider business mailing address

PO BOX 13186
TORRANCE CA
90503-0186
US

V. Phone/Fax

Practice location:
  • Phone: 310-670-0116
  • Fax: 310-316-9388
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH T CHAN
Title or Position: DIRECTOR
Credential:
Phone: 310-670-0116