Provider Demographics
NPI:1336215417
Name:DAULAT, BHALCHANDRA LAXMICHAND (PT)
Entity Type:Individual
Prefix:MR
First Name:BHALCHANDRA
Middle Name:LAXMICHAND
Last Name:DAULAT
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 1:10216 GARLAND RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2921
Mailing Address - Country:US
Mailing Address - Phone:214-321-2800
Mailing Address - Fax:214-321-2872
Practice Address - Street 1:10216 GARLAND RD
Practice Address - Street 2:SUITE B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2921
Practice Address - Country:US
Practice Address - Phone:214-321-2800
Practice Address - Fax:214-321-2872
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1005882174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650186Medicare ID - Type UnspecifiedLICENSED PHYSICAL THER