Healthcare Provider Details

I. General information

NPI: 1568929644
Provider Name (Legal Business Name): FYZICAL PAOLI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DARBY RD STE 1
PAOLI PA
19301-1481
US

IV. Provider business mailing address

40 DARBY RD STE 1
PAOLI PA
19301-1481
US

V. Phone/Fax

Practice location:
  • Phone: 917-558-3353
  • Fax:
Mailing address:
  • Phone: 917-558-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TALAR CHALIAN
Title or Position: MANAGING DIRECTOR, OWNER
Credential:
Phone: 917-558-3353