Provider Demographics
NPI:1982456489
Name:THAKKAR, BHAVYA ASHISH
Entity Type:Individual
Prefix:
First Name:BHAVYA
Middle Name:ASHISH
Last Name:THAKKAR
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 1:7346 PARKRIDGE BLVD APT 260
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-8252
Mailing Address - Country:US
Mailing Address - Phone:469-545-7213
Mailing Address - Fax:
Practice Address - Street 1:2700 W PLEASANT RUN RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1079
Practice Address - Country:US
Practice Address - Phone:469-545-7213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1390877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist