Individual provider Active NPI

Pan U Chan

  • Physical Therapist
  • Revere, MA
National Provider Identifier
1003712506
Registry record updated Oct 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
40 Furlong Dr FL 1
Revere, MA 02151-4006
Phone
(781) 951-3515
Fax
(781) 951-3514
NPI assigned
Oct 20, 2026
Last updated
Oct 20, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X MA Primary

Addresses

Primary practice location

40 Furlong Dr FL 1
Revere, MA 02151-4006

Mailing address

576 Broadhollow Rd
Melville, NY 11747-5012

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1792454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792454400000",
    "number": "1003712506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 BROADHOLLOW RD",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117475012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 FURLONG DR FL 1",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021514006",
            "telephone_number": "781-951-3515",
            "fax_number": "781-951-3514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "PAN U",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-10-20",
        "last_updated": "2026-10-20",
        "certification_date": "2026-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Revere, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.