Provider Demographics
NPI:1356770218
Name:DHUMALE, TARAL (PT)
Entity type:Individual
Prefix:
First Name:TARAL
Middle Name:
Last Name:DHUMALE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 QUEENS BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1606
Mailing Address - Country:US
Mailing Address - Phone:718-729-5947
Mailing Address - Fax:718-729-9168
Practice Address - Street 1:4701 QUEENS BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1606
Practice Address - Country:US
Practice Address - Phone:718-729-5947
Practice Address - Fax:718-729-9168
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032580-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist