Provider Demographics
NPI:1245518877
Name:TAL, MICHAL (PT)
Entity type:Individual
Prefix:
First Name:MICHAL
Middle Name:
Last Name:TAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 QUARTZ AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-1942
Mailing Address - Country:US
Mailing Address - Phone:856-906-1516
Mailing Address - Fax:
Practice Address - Street 1:12626 RIVERSIDE DR
Practice Address - Street 2:STE 301
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3473
Practice Address - Country:US
Practice Address - Phone:818-760-0110
Practice Address - Fax:818-301-0137
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist