Provider Demographics
NPI:1740802859
Name:CHAWDHURY, KABBYODEV ROY (DPT)
Entity Type:Individual
Prefix:DR
First Name:KABBYODEV
Middle Name:ROY
Last Name:CHAWDHURY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N PLYMOUTH WAY
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-4173
Mailing Address - Country:US
Mailing Address - Phone:909-800-3749
Mailing Address - Fax:
Practice Address - Street 1:145 N PLYMOUTH WAY
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-4173
Practice Address - Country:US
Practice Address - Phone:909-800-3749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist