Provider Demographics
NPI:1851675409
Name:VYAS, SANDIP H (PT)
Entity Type:Individual
Prefix:
First Name:SANDIP
Middle Name:H
Last Name:VYAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CHESTNUT CIR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2957
Mailing Address - Country:US
Mailing Address - Phone:571-275-2043
Mailing Address - Fax:
Practice Address - Street 1:123 CHESTNUT CIR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2957
Practice Address - Country:US
Practice Address - Phone:571-275-2043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist