Provider Demographics
NPI:1851348767
Name:HAZARIWALA, DEEPALI RAMESH (PTA)
Entity type:Individual
Prefix:MS
First Name:DEEPALI
Middle Name:RAMESH
Last Name:HAZARIWALA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:136 CHESTNUT XING DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2672
Mailing Address - Country:US
Mailing Address - Phone:302-738-9186
Mailing Address - Fax:
Practice Address - Street 1:RT 24 BACK BAY FARM RD
Practice Address - Street 2:
Practice Address - City:LONG NECK
Practice Address - State:DE
Practice Address - Zip Code:19966
Practice Address - Country:US
Practice Address - Phone:302-947-9662
Practice Address - Fax:302-947-9692
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0000643225200000X
PATE007591225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant