Provider Demographics
NPI:1992312003
Name:TALLAPALLI, RACHANA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:RACHANA
Middle Name:
Last Name:TALLAPALLI
Suffix:
Gender:F
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 1:4995 SW 164TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4948
Mailing Address - Country:US
Mailing Address - Phone:954-632-9986
Mailing Address - Fax:
Practice Address - Street 1:1951 SW 172ND AVE STE 109
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5613
Practice Address - Country:US
Practice Address - Phone:954-538-4760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist