Provider Demographics
NPI:1831943190
Name:KUKADIYA, KHUSHALI TEJASBHAI (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:KHUSHALI
Middle Name:TEJASBHAI
Last Name:KUKADIYA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PATERSON ST APT 2R
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2724
Mailing Address - Country:US
Mailing Address - Phone:409-454-2143
Mailing Address - Fax:
Practice Address - Street 1:4160 MAIN ST STE 201B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3899
Practice Address - Country:US
Practice Address - Phone:718-886-6696
Practice Address - Fax:347-732-9367
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist