Provider Demographics
NPI:1083853733
Name:CHAN, JOHN PHILIP GAN (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PHILIP GAN
Last Name:CHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4444 FOREST PARK AVE
Mailing Address - Street 2:C B 8502
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2212
Mailing Address - Country:US
Mailing Address - Phone:314-286-1940
Mailing Address - Fax:314-286-1473
Practice Address - Street 1:4444 FOREST PARK AVE
Practice Address - Street 2:SUITE 1210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2212
Practice Address - Country:US
Practice Address - Phone:314-286-1940
Practice Address - Fax:314-286-1473
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011016240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist