Provider Demographics
NPI:1073157905
Name:PATEL, RUCHA SAPAN (PT)
Entity type:Individual
Prefix:
First Name:RUCHA
Middle Name:SAPAN
Last Name:PATEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RUCHA
Other - Middle Name:
Other - Last Name:VANSDADIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:803-812-3656
Mailing Address - Fax:
Practice Address - Street 1:4802 LAKEVIEW PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4041
Practice Address - Country:US
Practice Address - Phone:469-863-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1333503225100000X
CAPT297258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist