Provider Demographics
NPI:1326476706
Name:PANDYA, PRIYANKA (PT)
Entity Type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:PANDYA
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 1:6000 HILLANDALE DR STE 145
Mailing Address - Street 2:
Mailing Address - City:STONECREST
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4860
Mailing Address - Country:US
Mailing Address - Phone:678-418-8072
Mailing Address - Fax:678-518-0137
Practice Address - Street 1:6000 HILLANDALE DR STE 145
Practice Address - Street 2:
Practice Address - City:STONECREST
Practice Address - State:GA
Practice Address - Zip Code:30058
Practice Address - Country:US
Practice Address - Phone:678-418-8072
Practice Address - Fax:678-518-0137
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036916225100000X
GA013482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist