Provider Demographics
NPI:1073905576
Name:PATEL, MAYURI (PTA)
Entity Type:Individual
Prefix:
First Name:MAYURI
Middle Name:
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:PO BOX 2994
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-0994
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7615 CANYON MEADOW CIR
Practice Address - Street 2:UNIT E
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4719
Practice Address - Country:US
Practice Address - Phone:949-413-9820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-21
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10455225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant