Carolyn Jessica Chan, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT298690 Issued in CA

Practice address

2115 Montiel Rd Ste 103
San Marcos, CA 92069-3587

Phone

(760) 839-2905

Fax

(760) 839-2901

NPI assigned

Oct 13, 2020

Last updated

Oct 14, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Select San Diego Physical Therapy PCGroup PAC ID 4981088994, 58 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Select San Diego Physical Therapy, PC.

  dba Select Physical Therapy

  • Physical Therapy Clinic/Center
  • San Diego, CA
  • NPI 1700516408
  Medicare reassignment Care Compare group NPD
• Select San Diego Physical Therapy, PC.

  dba Select Physical Therapy

  • Physical Therapy Clinic/Center
  • La Mesa, CA
  • NPI 1164152880
  NPD
• Select San Diego Physical Therapy, PC.

  dba Select Physical Therapy

  • Physical Therapy Clinic/Center
  • San Diego, CA
  • NPI 1992435606

  Physical Therapist

  NPD

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1023616901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3760 CONVOY ST STE 101",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921113743",
            "telephone_number": "858-264-1434",
            "fax_number": "858-751-0901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 MONTIEL RD STE 103",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920693587",
            "telephone_number": "760-839-2905",
            "fax_number": "760-839-2901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "CAROLYN",
        "middle_name": "JESSICA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-13",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT298690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reny Chacko, DDS
• Juan Chacon Vargas
• Stephanie Chacon
• Chad Pexton DDS PC
• Sarvenaz Chaichian, DMD
• Janice Ying-Tung Chan
• Jeanie Wing-Yee Chan
• Risha Chandiok
• Shreya Chandra, MD
• Daiana Lamarque Chapman, MFT

• Physical Therapist in San Marcos, CA
• Providers in San Marcos, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.