Provider Demographics
NPI:1811508948
Name:CHATILA, JAD AHMAD (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAD
Middle Name:AHMAD
Last Name:CHATILA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5428 OLD ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-5006
Mailing Address - Country:US
Mailing Address - Phone:972-352-8938
Mailing Address - Fax:
Practice Address - Street 1:12650 N BEACH ST STE 150
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4243
Practice Address - Country:US
Practice Address - Phone:817-402-0218
Practice Address - Fax:844-537-3572
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1335453225100000X
TX1335453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist