Provider Demographics
NPI:1932341807
Name:PANDYA, HIRAL V (DPT)
Entity type:Individual
Prefix:MISS
First Name:HIRAL
Middle Name:V
Last Name:PANDYA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HIRAL
Other - Middle Name:V
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:5665 DALLAS PKWY
Practice Address - Street 2:STE 110
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7372
Practice Address - Country:US
Practice Address - Phone:972-979-6577
Practice Address - Fax:972-979-6951
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014414225100000X
IL070019669225100000X
TX1270559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400101305Medicare PIN
ILF400132112Medicare PIN