Healthcare Provider Details

I. General information

NPI: 1124699251
Provider Name (Legal Business Name): PRIYANK MISTRY PT, DPT, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 BARKER ST
SILVER SPRING MD
20910-1001
US

IV. Provider business mailing address

10262 LAKE LINGANORE BLVD
NEW MARKET MD
21774-6883
US

V. Phone/Fax

Practice location:
  • Phone: 301-565-0300
  • Fax: 301-565-6794
Mailing address:
  • Phone: 201-640-1582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27757
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: