Provider Demographics
NPI:1164241493
Name:PAN, KE (DPT)
Entity type:Individual
Prefix:
First Name:KE
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3128 MERCER UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-5630
Mailing Address - Country:US
Mailing Address - Phone:470-439-8680
Mailing Address - Fax:
Practice Address - Street 1:3945 HOLCOMB BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-5200
Practice Address - Country:US
Practice Address - Phone:770-840-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT017445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist