Provider Demographics
NPI:1750981502
Name:DAVDA, PARIKSHIT JAYANT
Entity type:Individual
Prefix:DR
First Name:PARIKSHIT
Middle Name:JAYANT
Last Name:DAVDA
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 1:4550 N MAJOR DR APT 2324
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-8679
Mailing Address - Country:US
Mailing Address - Phone:409-291-6001
Mailing Address - Fax:
Practice Address - Street 1:1620 MAGBOLIA STREET
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575
Practice Address - Country:US
Practice Address - Phone:936-336-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1257519261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy