Provider Demographics
NPI:1528175338
Name:VAIDYA, MEHUL KISHORCHANDRA (PT)
Entity type:Individual
Prefix:
First Name:MEHUL
Middle Name:KISHORCHANDRA
Last Name:VAIDYA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32858 FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3048
Mailing Address - Country:US
Mailing Address - Phone:734-657-5055
Mailing Address - Fax:734-525-3001
Practice Address - Street 1:32858 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3048
Practice Address - Country:US
Practice Address - Phone:734-657-5055
Practice Address - Fax:734-525-3001
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist