Provider Demographics
NPI:1487497921
Name:PARVIZI, KYDEEN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KYDEEN
Middle Name:
Last Name:PARVIZI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4337 W OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8638
Mailing Address - Country:US
Mailing Address - Phone:801-822-1880
Mailing Address - Fax:
Practice Address - Street 1:9499 FARM ROAD 269 S
Practice Address - Street 2:
Practice Address - City:PICKTON
Practice Address - State:TX
Practice Address - Zip Code:75471-4524
Practice Address - Country:US
Practice Address - Phone:801-822-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1315369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist