Provider Demographics
NPI:1215475348
Name:PATEL, CHINMAY (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:CHINMAY
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
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 1:910 S MOUNTAIN AVENUE UNITE A
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762
Mailing Address - Country:US
Mailing Address - Phone:262-327-1535
Mailing Address - Fax:
Practice Address - Street 1:910 S MOUNTAIN AVENUE UNITE A
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762
Practice Address - Country:US
Practice Address - Phone:262-327-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist