Provider Demographics
NPI:1346600913
Name:KANCHWALA, FATEMA (DPT)
Entity Type:Individual
Prefix:
First Name:FATEMA
Middle Name:
Last Name:KANCHWALA
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 1:633 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2207
Mailing Address - Country:US
Mailing Address - Phone:781-444-1614
Mailing Address - Fax:781-444-9260
Practice Address - Street 1:633 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2207
Practice Address - Country:US
Practice Address - Phone:781-444-1614
Practice Address - Fax:781-444-9260
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist