Provider Demographics
NPI:1710096698
Name:TALATI, PETER L (RPT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:L
Last Name:TALATI
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 DIANA DR
Mailing Address - Street 2:UNIT-301
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4823
Mailing Address - Country:US
Mailing Address - Phone:954-558-0001
Mailing Address - Fax:
Practice Address - Street 1:7501 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE-306
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4982
Practice Address - Country:US
Practice Address - Phone:954-578-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6674225100000X
IN05008321A225100000X
TX1158677225100000X
SC4992225100000X
NC9940225100000X
FLPT16802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F1007Medicare ID - Type UnspecifiedPHYSICAL THERAPIST
AZ104867Medicare ID - Type UnspecifiedPHYSICAL THERAPIST
FLY7282BMedicare ID - Type UnspecifiedPHYSICAL THERAPIST
IN216160AMedicare ID - Type UnspecifiedPHYSICAL THERAPIST
NC2506689Medicare ID - Type UnspecifiedPHYSICAL THERAPIST