Provider Demographics
NPI:1255455259
Name:DALAL, RAJIV ASHWIN (MS, PT)
Entity type:Individual
Prefix:MR
First Name:RAJIV
Middle Name:ASHWIN
Last Name:DALAL
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8736 LAUREL CANYON RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3916
Mailing Address - Country:US
Mailing Address - Phone:407-770-7388
Mailing Address - Fax:
Practice Address - Street 1:8736 LAUREL CANYON RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3916
Practice Address - Country:US
Practice Address - Phone:407-770-7388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1171190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist