Provider Demographics
NPI:1821860693
Name:HYLIC PHYSICAL THERAPY APC
Entity Type:Organization
Organization Name:HYLIC PHYSICAL THERAPY APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHVAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:248-821-1325
Mailing Address - Street 1:9840 MIRA LEE WAY APT 20212
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4755
Mailing Address - Country:US
Mailing Address - Phone:248-821-1325
Mailing Address - Fax:
Practice Address - Street 1:9840 MIRA LEE WAY APT 20212
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4755
Practice Address - Country:US
Practice Address - Phone:248-821-1325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No251E00000XAgenciesHome Health