Individual
JEKIN JAYANTKUMAR VYAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
171 ELDEN ST STE 140A, HERNDON, VA 20170-4834
(214) 604-5886
Mailing address
25497 BERESFORD DR, CHANTILLY, VA 20152-3901
(214) 604-5886
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305212882
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2305212882
LICENSE
VA
Enumeration date
12/21/2017
Last updated
11/22/2024
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