Provider Demographics
NPI:1902329212
Name:VAIDYA, RICHA S (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:RICHA
Middle Name:S
Last Name:VAIDYA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4433 TRANQUILITY TRL
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1242
Mailing Address - Country:US
Mailing Address - Phone:847-347-5254
Mailing Address - Fax:
Practice Address - Street 1:701 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PROPHETSTOWN
Practice Address - State:IL
Practice Address - Zip Code:61277-1334
Practice Address - Country:US
Practice Address - Phone:847-347-5254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.022681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty