Provider Demographics
NPI:1588921399
Name:PATEL, MITALBEN R (PTA)
Entity type:Individual
Prefix:
First Name:MITALBEN
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14021 32ND AVE
Mailing Address - Street 2:APT#3F-N
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2613
Mailing Address - Country:US
Mailing Address - Phone:347-870-3097
Mailing Address - Fax:
Practice Address - Street 1:14021 32ND AVE
Practice Address - Street 2:APT#3F-N
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2613
Practice Address - Country:US
Practice Address - Phone:347-870-3097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008224225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant