Provider Demographics
NPI:1942493069
Name:CHIDWAL, PANKAJ (BPT, MSPT)
Entity type:Individual
Prefix:MR
First Name:PANKAJ
Middle Name:
Last Name:CHIDWAL
Suffix:
Gender:M
Credentials:BPT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 PIEDMONT ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-2100
Mailing Address - Country:US
Mailing Address - Phone:203-848-7521
Mailing Address - Fax:
Practice Address - Street 1:41 GERMANTOWN RD
Practice Address - Street 2:SUITE B-02
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4087
Practice Address - Country:US
Practice Address - Phone:203-207-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0079662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic