Provider Demographics
NPI:1063873289
Name:AVITAL, LIAT CHANA (DPT)
Entity type:Individual
Prefix:
First Name:LIAT
Middle Name:CHANA
Last Name:AVITAL
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41125 N DAISY MOUNTAIN DR STE 125
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-4964
Mailing Address - Country:US
Mailing Address - Phone:480-265-2132
Mailing Address - Fax:623-551-5078
Practice Address - Street 1:14001 N 7TH ST STE F112
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4382
Practice Address - Country:US
Practice Address - Phone:480-265-2140
Practice Address - Fax:480-265-2141
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32828208100000X, 225100000X
NY040027-1225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic