Provider Demographics
NPI:1558893784
Name:PAN, HAROLD HENROE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:HENROE
Last Name:PAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 E CHAPMAN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2151
Mailing Address - Country:US
Mailing Address - Phone:714-538-1952
Mailing Address - Fax:714-538-1940
Practice Address - Street 1:1026 E CHAPMAN AVE STE B
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2151
Practice Address - Country:US
Practice Address - Phone:714-538-1952
Practice Address - Fax:714-538-1490
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist