Provider Demographics
NPI:1649853201
Name:VYAS, RITU SANJAYKUMAR
Entity type:Individual
Prefix:MS
First Name:RITU
Middle Name:SANJAYKUMAR
Last Name:VYAS
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 1:20 STAGG ST APT 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3490
Mailing Address - Country:US
Mailing Address - Phone:346-907-2515
Mailing Address - Fax:
Practice Address - Street 1:GB PHYSICAL THERAPY PC
Practice Address - Street 2:900 B EAST TREMONT AVENUE
Practice Address - City:BRONX,NYC
Practice Address - State:NY
Practice Address - Zip Code:10460
Practice Address - Country:US
Practice Address - Phone:917-514-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist