Healthcare Provider Details

I. General information

NPI: 1619667946
Provider Name (Legal Business Name): WESLEY CHAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3154 DE FOREST RD STE B
MARINA CA
93933-2771
US

IV. Provider business mailing address

143 JOHN ST
SALINAS CA
93901-3337
US

V. Phone/Fax

Practice location:
  • Phone: 831-422-4782
  • Fax: 831-422-4784
Mailing address:
  • Phone: 831-422-4782
  • Fax: 831-422-4784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number304039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: