Provider Demographics
NPI:1336795046
Name:TOH, JAN MABEL CHAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAN MABEL
Middle Name:CHAN
Last Name:TOH
Suffix:
Gender:F
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 1:346 14TH ST APT 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5087
Mailing Address - Country:US
Mailing Address - Phone:713-504-5356
Mailing Address - Fax:
Practice Address - Street 1:6010 BAY PKWY FL 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6079
Practice Address - Country:US
Practice Address - Phone:718-283-6087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-18
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist