Provider Demographics
NPI:1477226728
Name:CHAN, JANEN PABELLO (RPT)
Entity Type:Individual
Prefix:
First Name:JANEN
Middle Name:PABELLO
Last Name:CHAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 LINCOLN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4232
Mailing Address - Country:US
Mailing Address - Phone:562-644-9280
Mailing Address - Fax:
Practice Address - Street 1:701 E 28TH ST STE 111
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2715
Practice Address - Country:US
Practice Address - Phone:562-426-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist