Provider Demographics
NPI:1023369717
Name:VYAS, KHUSHBU (DPT)
Entity Type:Individual
Prefix:
First Name:KHUSHBU
Middle Name:
Last Name:VYAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KHUSHBU
Other - Middle Name:
Other - Last Name:VYAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:11010 WINDSOR CLUB CT
Mailing Address - Street 2:APT 109
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7799
Mailing Address - Country:US
Mailing Address - Phone:239-910-1051
Mailing Address - Fax:
Practice Address - Street 1:11010 WINDSOR CLUB CT
Practice Address - Street 2:APT 109
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7799
Practice Address - Country:US
Practice Address - Phone:239-910-1051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60017704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist