Provider Demographics
NPI:1881059749
Name:BHADIYADRA, BIJAL GIRISHKUMAR
Entity type:Individual
Prefix:
First Name:BIJAL
Middle Name:GIRISHKUMAR
Last Name:BHADIYADRA
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 1:10151 CAMINO RUIZ
Mailing Address - Street 2:APT 30
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-6402
Mailing Address - Country:US
Mailing Address - Phone:916-425-3557
Mailing Address - Fax:
Practice Address - Street 1:465 GRAND ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4800
Practice Address - Country:US
Practice Address - Phone:212-420-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-19
Last Update Date:2015-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist