Provider Demographics
NPI:1588145957
Name:TIWARI, PIYUSH
Entity type:Individual
Prefix:
First Name:PIYUSH
Middle Name:
Last Name:TIWARI
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 1:22366 STILLWATER CT APT 3A
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-8958
Mailing Address - Country:US
Mailing Address - Phone:574-575-2815
Mailing Address - Fax:
Practice Address - Street 1:333 W MISHAWAKA RD
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-1921
Practice Address - Country:US
Practice Address - Phone:574-293-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist