Provider Demographics
NPI:1790176550
Name:CHABHADIYA, JIGNESH
Entity Type:Individual
Prefix:
First Name:JIGNESH
Middle Name:
Last Name:CHABHADIYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12837 BAY TREE WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-6536
Mailing Address - Country:US
Mailing Address - Phone:248-979-0161
Mailing Address - Fax:
Practice Address - Street 1:12837 BAY TREE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-6536
Practice Address - Country:US
Practice Address - Phone:248-979-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1214149225100000X
MI5501014880225100000X
IN05011662A225100000X
KY005966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist