Provider Demographics
NPI:1124699251
Name:MISTRY, PRIYANK (PT, DPT, MS)
Entity type:Individual
Prefix:DR
First Name:PRIYANK
Middle Name:
Last Name:MISTRY
Suffix:
Gender:M
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10262 LAKE LINGANORE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21774-6883
Mailing Address - Country:US
Mailing Address - Phone:201-640-1582
Mailing Address - Fax:
Practice Address - Street 1:2700 BARKER ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1001
Practice Address - Country:US
Practice Address - Phone:301-565-0300
Practice Address - Fax:301-565-6794
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist