Basic Information
| Provider Information | |||||||||
| NPI: | 1851348767 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAZARIWALA | ||||||||
| FirstName: | DEEPALI | ||||||||
| MiddleName: | RAMESH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136 CHESTNUT XING DR | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027389186 | ||||||||
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| Practice Location | |||||||||
| Address1: | RT 24 BACK BAY FARM RD | ||||||||
| Address2: | |||||||||
| City: | LONG NECK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3029479662 | ||||||||
| FaxNumber: | 3029479692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | J2-0000643 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | TE007591 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.