Provider Demographics
NPI:1700380581
Name:PANDYA, TANVI
Entity Type:Individual
Prefix:
First Name:TANVI
Middle Name:
Last Name:PANDYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 S CYPRESS BEND DR APT 109
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4414
Mailing Address - Country:US
Mailing Address - Phone:317-794-4967
Mailing Address - Fax:
Practice Address - Street 1:10250 NW 53RD ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-8023
Practice Address - Country:US
Practice Address - Phone:317-794-4967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist