MEDICARE: ELIZABETH JALALI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT015966	GA

General Provider Information

NPI Number	:	1861123705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH JALALI

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-4915
Country	:	US
Telephone Number	:	866-518-0283
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 LONG BRANCH RD UNIT 102
Second Line	:
City	:	DAHLONEGA
State	:	GA
Zip	:	30533-7132
Country	:	US
Telephone Number	:	706-864-0200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	08/28/2024

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