Provider Demographics
NPI:1912329194
Name:KAKADIYA, JIGNESHKUMAR (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JIGNESHKUMAR
Middle Name:
Last Name:KAKADIYA
Suffix:
Gender:M
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 1:3000 MADISON AVE
Mailing Address - Street 2:APT# A21
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-2573
Mailing Address - Country:US
Mailing Address - Phone:248-499-4772
Mailing Address - Fax:
Practice Address - Street 1:3000 MADISON AVE
Practice Address - Street 2:APT# A21
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-2573
Practice Address - Country:US
Practice Address - Phone:248-499-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 40585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist