Provider Demographics
NPI:1750749073
Name:DALAL, AMISHA
Entity type:Individual
Prefix:
First Name:AMISHA
Middle Name:
Last Name:DALAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 PISANO TER
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4329
Mailing Address - Country:US
Mailing Address - Phone:925-549-5814
Mailing Address - Fax:
Practice Address - Street 1:4456 BLACK AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6146
Practice Address - Country:US
Practice Address - Phone:925-426-6986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 41870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist