Provider Demographics
NPI:1073178356
Name:PATEL, ASHISH CHANDRAKANT (PTA)
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:CHANDRAKANT
Last Name:PATEL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6687 LAKEVIEW BLVD APT 6312
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-5824
Mailing Address - Country:US
Mailing Address - Phone:508-344-8911
Mailing Address - Fax:
Practice Address - Street 1:6687 LAKEVIEW BLVD APT 6312
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-5824
Practice Address - Country:US
Practice Address - Phone:508-344-8911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502003891225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant