Provider Demographics
NPI:1891992038
Name:CHAN, PAULA (PT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 STARR WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3058
Mailing Address - Country:US
Mailing Address - Phone:650-759-5177
Mailing Address - Fax:650-965-8545
Practice Address - Street 1:1235 PEAR AVE
Practice Address - Street 2:STE 101
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1444
Practice Address - Country:US
Practice Address - Phone:650-759-5177
Practice Address - Fax:650-965-8545
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT179002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic