Active NPI
John Philip Gan Chan, PT
- Physical Therapist
- Saint Louis, MO
National Provider Identifier
1083853733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2011016240
- Practice address
- 4444 Forest Park Ave
Suite 1210
Saint Louis, MO 63108-2212 - Phone
- (314) 286-1940
- Fax
- (314) 286-1473
- NPI assigned
- Feb 19, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2011016240 | MO | Primary |
Addresses
Primary practice location
4444 Forest Park Ave
Suite 1210
Saint Louis, MO 63108-2212
Mailing address
4444 Forest Park Ave
C B 8502
Saint Louis, MO 63108-2212
Phone (314) 286-1940
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2011016240 | MO | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Diversey Medical Center SC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- NPI 1720096969
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313625600000",
"number": "1083853733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4444 FOREST PARK AVE",
"address_2": "C B 8502",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631082212",
"telephone_number": "314-286-1940",
"fax_number": "314-286-1473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4444 FOREST PARK AVE",
"address_2": "SUITE 1210",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631082212",
"telephone_number": "314-286-1940",
"fax_number": "314-286-1473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "JOHN",
"middle_name": "PHILIP GAN",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-02-19",
"last_updated": "2011-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2011016240",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.