Provider Demographics
NPI:1497003826
Name:MERCHANT, KHYATI AJAY (PT, TDPT)
Entity type:Individual
Prefix:
First Name:KHYATI
Middle Name:AJAY
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:PT, TDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4074 WILD TURKEY LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-0063
Mailing Address - Country:US
Mailing Address - Phone:214-475-9362
Mailing Address - Fax:
Practice Address - Street 1:4833 BEREWICK TOWN CENTER DR STE H
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-6721
Practice Address - Country:US
Practice Address - Phone:980-880-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1198048225100000X
SC12295225100000X
NCP20976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20976OtherLICENSE