Provider Demographics
NPI:1033819024
Name:PATEL, DHRUVIBEN BHARATBHAI
Entity Type:Individual
Prefix:
First Name:DHRUVIBEN
Middle Name:BHARATBHAI
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18573 70TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-2261
Mailing Address - Country:US
Mailing Address - Phone:470-621-5687
Mailing Address - Fax:
Practice Address - Street 1:18573 70TH AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-2261
Practice Address - Country:US
Practice Address - Phone:470-621-5687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048333225100000X
NY12962225100000X
WI15938-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist