Provider Demographics
NPI:1366975039
Name:PATEL, MITESHKUMAR D (PT)
Entity type:Individual
Prefix:
First Name:MITESHKUMAR
Middle Name:D
Last Name:PATEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5128
Mailing Address - Country:US
Mailing Address - Phone:516-946-2503
Mailing Address - Fax:
Practice Address - Street 1:32 SURREY LN
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5128
Practice Address - Country:US
Practice Address - Phone:516-946-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-09
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist