Provider Demographics
NPI:1386944726
Name:PATEL, JAYESHKUMAR M (RPT)
Entity type:Individual
Prefix:
First Name:JAYESHKUMAR
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 OAKMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3319
Mailing Address - Country:US
Mailing Address - Phone:313-581-7971
Mailing Address - Fax:313-581-8028
Practice Address - Street 1:5445 OAKMAN BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3319
Practice Address - Country:US
Practice Address - Phone:313-581-7971
Practice Address - Fax:313-581-8028
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist