MEDICARE: MS. ISHA CHAWLA MSPT, CFMT

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	40QA01487800	NJ

General Provider Information

NPI Number	:	1871952713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ISHA CHAWLA MSPT, CFMT

Provider Business Mailing Address
First Line	:	122 LAAUWE AVE
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2655
Country	:	US
Telephone Number	:	917-635-5393
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 LAAUWE AVE
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-2655
Country	:	US
Telephone Number	:	917-635-5393
Fax Number	:

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

Provider Enumeration Date	:	02/21/2016
Last Update Date	:	06/15/2026

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