MEDICARE: MRS. NANCY CHAN P.T.

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	00PT88250	PW

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BA153	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1487694667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY CHAN P.T.

Provider Business Mailing Address
First Line	:	744 SAN ANTONIO RD STE 3
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94303-4624
Country	:	US
Telephone Number	:	650-494-0991
Fax Number	:	650-494-0129

Provider Business Practice Location Address
First Line	:	744 SAN ANTONIO RD STE 3
Second Line	:
City	:	PALO ALTO
State	:	CA
Zip	:	94303-4624
Country	:	US
Telephone Number	:	650-494-0991
Fax Number	:	650-494-0129

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	01/28/2009

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