Provider Demographics
NPI:1164808671
Name:ANTALA, PAYAL (DPT)
Entity Type:Individual
Prefix:
First Name:PAYAL
Middle Name:
Last Name:ANTALA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 ANDOVER ST
Mailing Address - Street 2:SUITE 211A
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1234 HYDE PARK AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2819
Practice Address - Country:US
Practice Address - Phone:617-364-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist