Provider Demographics
NPI:1639671738
Name:DHALLA, TRIPAT SIMRAN KAUR (PT)
Entity Type:Individual
Prefix:
First Name:TRIPAT SIMRAN
Middle Name:KAUR
Last Name:DHALLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 N OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-3756
Mailing Address - Country:US
Mailing Address - Phone:954-303-9950
Mailing Address - Fax:
Practice Address - Street 1:747 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4055
Practice Address - Country:US
Practice Address - Phone:954-316-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist