Provider Demographics
NPI:1083734461
Name:MALHOTRA, SUNIL (PT)
Entity Type:Individual
Prefix:
First Name:SUNIL
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9313 170TH PL
Mailing Address - Street 2:
Mailing Address - City:ORLAND HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60477-7257
Mailing Address - Country:US
Mailing Address - Phone:708-203-8724
Mailing Address - Fax:708-349-9035
Practice Address - Street 1:9313 170TH PL
Practice Address - Street 2:
Practice Address - City:ORLAND HILLS
Practice Address - State:IL
Practice Address - Zip Code:60477-7257
Practice Address - Country:US
Practice Address - Phone:708-203-8724
Practice Address - Fax:708-429-4395
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist