Provider Demographics
NPI:1346796828
Name:LALLA, VAISHALI VINOD (MPT)
Entity Type:Individual
Prefix:MRS
First Name:VAISHALI
Middle Name:VINOD
Last Name:LALLA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:VAISHALI
Other - Middle Name:VINOD
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:3033 SARNO RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7229
Mailing Address - Country:US
Mailing Address - Phone:321-255-9200
Mailing Address - Fax:
Practice Address - Street 1:3033 SARNO RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7229
Practice Address - Country:US
Practice Address - Phone:321-255-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 31444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist