Provider Demographics
NPI:1588948145
Name:PATEL, UTKARSH S (PT)
Entity type:Individual
Prefix:
First Name:UTKARSH
Middle Name:S
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 1:201 W GUAVA ST STE 206
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-1702
Mailing Address - Country:US
Mailing Address - Phone:352-205-9897
Mailing Address - Fax:888-426-0410
Practice Address - Street 1:201 W GUAVA ST STE 206
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-1702
Practice Address - Country:US
Practice Address - Phone:352-205-9897
Practice Address - Fax:888-426-0410
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist