Provider Demographics
NPI:1811644404
Name:PANCHAL, PALAK Y (PTA)
Entity type:Individual
Prefix:
First Name:PALAK
Middle Name:Y
Last Name:PANCHAL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8133 CHARFORD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-1638
Mailing Address - Country:US
Mailing Address - Phone:734-353-7372
Mailing Address - Fax:
Practice Address - Street 1:901 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2226
Practice Address - Country:US
Practice Address - Phone:817-335-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10859913-2402225200000X
TXCP004753A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant