Provider Demographics
NPI:1588358964
Name:DHALLA, FAHIM
Entity type:Individual
Prefix:
First Name:FAHIM
Middle Name:
Last Name:DHALLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 FLORIDA CENTRAL PKWY STE 1008
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5176
Mailing Address - Country:US
Mailing Address - Phone:407-720-4236
Mailing Address - Fax:
Practice Address - Street 1:556 FLORIDA CENTRAL PKWY STE 1008
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5176
Practice Address - Country:US
Practice Address - Phone:407-720-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist