Healthcare Provider Details

I. General information

NPI: 1750099644
Provider Name (Legal Business Name): JANKI PANDYA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 8TH ST
CLERMONT FL
34711-2159
US

IV. Provider business mailing address

698 BLUE CITRUS LN
MINNEOLA FL
34715-6108
US

V. Phone/Fax

Practice location:
  • Phone: 352-243-4422
  • Fax:
Mailing address:
  • Phone: 352-801-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT39529
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: