Provider Demographics
NPI:1083487854
Name:PATEL, KINJAL CHIRAG
Entity Type:Individual
Prefix:MS
First Name:KINJAL
Middle Name:CHIRAG
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KINJAL
Other - Middle Name:SURESHKUMAR
Other - Last Name:MANDAWAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 SE MOBERLY LN STE 6
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7017
Mailing Address - Country:US
Mailing Address - Phone:479-403-9205
Mailing Address - Fax:479-268-5144
Practice Address - Street 1:1800 SE MOBERLY LN STE 6
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7017
Practice Address - Country:US
Practice Address - Phone:479-403-9205
Practice Address - Fax:479-268-5144
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT-5408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist