Provider Demographics
NPI:1578848511
Name:KAUSHAL, PRIYANKA D (DPT)
Entity Type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:D
Last Name:KAUSHAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 TOURNAMENT DR N
Mailing Address - Street 2:
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8401
Mailing Address - Country:US
Mailing Address - Phone:917-569-0746
Mailing Address - Fax:
Practice Address - Street 1:79 TOURNAMENT DR N
Practice Address - Street 2:
Practice Address - City:HAWTHORN WOODS
Practice Address - State:IL
Practice Address - Zip Code:60047-8401
Practice Address - Country:US
Practice Address - Phone:917-569-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033654225100000X
IL070020421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist