| Doctor Name: | JITAL J PANCHOLI |
| NPI Number: | 1093024747 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | PT010003 |
| Business Practice Address: | 5775 Old Winder Hwy Braselton, GA - 305171603 |
| Business Phone Number: | 6788664104 |
| Business Fax Number: | 6788664104 |
| Mailing Address: | 1655 Centerview Dr Apt 1721, DULUTH |
| State: | GA |
| Postal Code: | 300965951 |
| Phone Number: | 4043684371 |
| Fax Number: | |
| NPI Enumeration Date: | 09/29/2010 |
| NPI Last Update Date: | 07/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | PT010003 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |