Basic Information
| Provider Information | |||||||||
| NPI: | 1811508948 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHATILA | ||||||||
| FirstName: | JAD | ||||||||
| MiddleName: | AHMAD | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5428 OLD ORCHARD DR | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761235006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723528938 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12650 N BEACH ST STE 150 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762444243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174020218 | ||||||||
| FaxNumber: | 8445373572 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2020 | ||||||||
| LastUpdateDate: | 07/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1335453 | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 1335453 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.