Provider Demographics
NPI:1609358324
Name:PANCHAL, YATINKUMAR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:YATINKUMAR
Middle Name:
Last Name:PANCHAL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8133 CHARFORD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1638
Mailing Address - Country:US
Mailing Address - Phone:734-548-2231
Mailing Address - Fax:
Practice Address - Street 1:120 MEADOW VIEW DR
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247-9639
Practice Address - Country:US
Practice Address - Phone:940-648-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1256211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist