Provider Demographics
NPI:1275196826
Name:FOULADI, YASHAR CHRIS
Entity Type:Individual
Prefix:
First Name:YASHAR
Middle Name:CHRIS
Last Name:FOULADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8493 FAIRBANKS ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-4959
Mailing Address - Country:US
Mailing Address - Phone:219-808-9117
Mailing Address - Fax:
Practice Address - Street 1:8493 FAIRBANKS ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4959
Practice Address - Country:US
Practice Address - Phone:219-808-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant