Provider Demographics
NPI:1073996310
Name:VYAS, JIGAR D (PT)
Entity Type:Individual
Prefix:
First Name:JIGAR
Middle Name:D
Last Name:VYAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 E MICHIGAN ST STE 334
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4553
Mailing Address - Country:US
Mailing Address - Phone:407-574-3027
Mailing Address - Fax:407-574-3037
Practice Address - Street 1:296 E MICHIGAN ST STE 334
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4553
Practice Address - Country:US
Practice Address - Phone:407-574-3027
Practice Address - Fax:407-574-3037
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011685225100000X
FLPT 30037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist