Provider Demographics
NPI:1396455952
Name:VYAS, RUTVI VIJAY
Entity type:Individual
Prefix:
First Name:RUTVI
Middle Name:VIJAY
Last Name:VYAS
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 1:1010 SUNRISE HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5100
Mailing Address - Country:US
Mailing Address - Phone:516-442-5164
Mailing Address - Fax:
Practice Address - Street 1:1010 SUNRISE HWY STE 2
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5100
Practice Address - Country:US
Practice Address - Phone:516-442-5164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04989801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist