Provider Demographics
NPI:1467501445
Name:CHAN, SANDRA LEIGH (PT)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LEIGH
Last Name:CHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEIGH
Other - Last Name:KAN CHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10050 N WOLFE RD STE SW1190
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2595
Mailing Address - Country:US
Mailing Address - Phone:408-236-6121
Mailing Address - Fax:
Practice Address - Street 1:10050 N WOLFE RD
Practice Address - Street 2:SW1-190
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2519
Practice Address - Country:US
Practice Address - Phone:408-236-6162
Practice Address - Fax:408-236-6152
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 139762251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic