Provider Demographics
NPI:1366802852
Name:CHAN, ALFIE ROMAN D (PT)
Entity type:Individual
Prefix:MR
First Name:ALFIE ROMAN
Middle Name:D
Last Name:CHAN
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:11024 BALBOA BLVD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344
Mailing Address - Country:US
Mailing Address - Phone:818-363-3000
Mailing Address - Fax:888-833-2881
Practice Address - Street 1:2105 BEVERLY BLVD
Practice Address - Street 2:SUITE 231
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-483-1726
Practice Address - Fax:213-483-1733
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2016-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA225100000X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic