Provider Demographics
NPI:1164935813
Name:CHAN, GARRISON AKIO-LEE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:GARRISON
Middle Name:AKIO-LEE
Last Name:CHAN
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6339
Mailing Address - Country:US
Mailing Address - Phone:310-318-3241
Mailing Address - Fax:
Practice Address - Street 1:7400 OLD MAIN HL
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84322-7400
Practice Address - Country:US
Practice Address - Phone:424-200-0589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer