Provider Demographics
NPI:1275957961
Name:PATEL, RAVI MADHUSUDAN (PT)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:MADHUSUDAN
Last Name:PATEL
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:PATEL
Other - Middle Name:RAVIKUMAR
Other - Last Name:MADHUSUDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:104 HICKORY CORNER RD STE 205
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2460
Mailing Address - Country:US
Mailing Address - Phone:609-630-0508
Mailing Address - Fax:609-606-7845
Practice Address - Street 1:104 HICKORY CORNER RD STE 205
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2460
Practice Address - Country:US
Practice Address - Phone:609-630-0508
Practice Address - Fax:609-606-7845
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02238400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist