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General NPI Number Information
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NPI Number | 1376616268
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Entity Type | Individual
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Provider Name | DOUGLAS KENDRICK CHAN PT
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 3767 FETTLER PARK DRIVE
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City | DUMFRIES
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State | VA
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Zip | 22025
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Country | US
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Telephone | 703-730-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 4328 TARPON LN
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City | ALEXANDRIA
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State | VA
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Zip | 22309-3135
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Country | US
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Telephone | 703-780-0188
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305006554
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License Number State | VA
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