Provider Demographics
NPI:1831400563
Name:VAIDYA, ABHIJEET (PT)
Entity type:Individual
Prefix:MR
First Name:ABHIJEET
Middle Name:
Last Name:VAIDYA
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 1:34825 BIRCHGROVE DR APT A
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-4751
Mailing Address - Country:US
Mailing Address - Phone:248-719-4827
Mailing Address - Fax:
Practice Address - Street 1:34825 BIRCHGROVE DR APT A
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-4751
Practice Address - Country:US
Practice Address - Phone:248-719-4827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist