Justin Pan

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

15130 Issued in TN

Practice address

2158 Northgate Park LN Ste 200
Chattanooga, TN 37415-6911

Phone

(423) 254-5461

NPI assigned

Sep 13, 2023

Sex

Male

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 TN, GA2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Excel Rehabilitation and SportsGroup PAC ID 1759481559, 53 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Excel Rehabilitation and Sports

  • Physical Therapist
  • Clemson, SC
  • NPI 1740358324

  GA, TN

  Medicare reassignment Care Compare group NPD
• Excel Rehabilitation and Sports

  • Physical Therapist
  • Greenville, SC
  • NPI 1952272379
  NPD

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

{
    "created_epoch": "1694563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1366229262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 KENMOOR AVE SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2158 NORTHGATE PARK LN STE 200",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374156911",
            "telephone_number": "423-254-5461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAN",
        "first_name": "JUSTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-13",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "15130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dayna Malissa Palmer
• Robert Palmer, SLP-CCC
• Sarah Palmer, MAT, LAT, ATC
• Jessica Palmier
• Pamela Bookout, PRT PC
• Mukta Panda, MD
• Lotika Pandit, MD
• Emma Panepucci, M.S. CCC-SLP
• Pearl Pangkey, PTA
• Christopher Pankiw, MD

• Physical Therapist in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; 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.