Organization
SHYAM ULLAL,PT A PROF.CORP
Active
Other names
Frontier Worker Fitness & Therapy Sevices
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHYAM S ULLAL P.T. (CEO/OWNER)
(760) 357-8864
Entity
Organization
Contact information
Practice address
408 E 3RD ST, SUITE F, CALEXICO, CA 92231-2854
(760) 357-8864
(760) 357-8866
Mailing address
2330 SANDALWOOD DRIVE, EL CENTRO, CA 92243-3674
(760) 357-8864
(760) 357-8866
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT 10423
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WPT10423A
INDIVDUAL PTAN
CA
Enumeration date
10/22/2007
Last updated
11/20/2007
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