Healthcare Provider Details

I. General information

NPI: 1821924036
Provider Name (Legal Business Name): ETHAN RYAN QUAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 15TH ST STE 36
SAN FRANCISCO CA
94103-5032
US

IV. Provider business mailing address

149 MARVIEW WAY
SAN FRANCISCO CA
94131-1219
US

V. Phone/Fax

Practice location:
  • Phone: 415-701-1000
  • Fax:
Mailing address:
  • Phone: 415-819-6350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: