Provider Demographics
NPI:1912201369
Name:TALATI, PERCY BOMAN (RPT)
Entity Type:Individual
Prefix:
First Name:PERCY
Middle Name:BOMAN
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 1:2118 INWOOD DR
Mailing Address - Street 2:STE 102
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7124
Mailing Address - Country:US
Mailing Address - Phone:260-483-9081
Mailing Address - Fax:260-483-9196
Practice Address - Street 1:2118 INWOOD DR
Practice Address - Street 2:STE 102
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7101
Practice Address - Country:US
Practice Address - Phone:260-483-9081
Practice Address - Fax:260-483-9196
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN05000365A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist