Provider Demographics
NPI:1780328096
Name:CHAN, TAWNY (DPT)
Entity type:Individual
Prefix:
First Name:TAWNY
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 CENTRAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2740
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:909-581-6280
Practice Address - Street 1:1280 CORONA POINTE CT STE 118
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1770
Practice Address - Country:US
Practice Address - Phone:951-340-3402
Practice Address - Fax:951-340-3416
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARPT4984225100000X, 2251P0200X
CA302085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics