Provider Demographics
NPI:1336869056
Name:DAVE, KHYATI NIKUNJ
Entity Type:Individual
Prefix:
First Name:KHYATI
Middle Name:NIKUNJ
Last Name:DAVE
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 1:7010 LAKE NONA BLVD BLDG APT 122
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7608
Mailing Address - Country:US
Mailing Address - Phone:954-849-6212
Mailing Address - Fax:
Practice Address - Street 1:9682 LAKE NONA VILLAGE PL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7315
Practice Address - Country:US
Practice Address - Phone:954-849-6212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics