Provider Demographics
NPI:1699372755
Name:MISTRY, DRAVYA (PT)
Entity Type:Individual
Prefix:MISS
First Name:DRAVYA
Middle Name:
Last Name:MISTRY
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 1:2130 E BAY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2323
Mailing Address - Country:US
Mailing Address - Phone:727-587-0582
Mailing Address - Fax:727-587-0583
Practice Address - Street 1:2130 E BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2323
Practice Address - Country:US
Practice Address - Phone:727-587-0582
Practice Address - Fax:727-587-0583
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2023-09-11
Deactivation Date:2023-08-24
Deactivation Code:
Reactivation Date:2023-09-11
Provider Licenses
StateLicense IDTaxonomies
NY046048225100000X
FLPT40385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist