Provider Demographics
NPI:1386265833
Name:PATEL, TEJASVA R (PT)
Entity type:Individual
Prefix:MS
First Name:TEJASVA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 N I 35 STE 100
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-3432
Mailing Address - Country:US
Mailing Address - Phone:940-483-9020
Mailing Address - Fax:940-483-9021
Practice Address - Street 1:4401 N I 35 STE 100
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76207-3432
Practice Address - Country:US
Practice Address - Phone:940-483-9020
Practice Address - Fax:940-483-9021
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1384797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist