Provider Demographics
NPI:1093468555
Name:PATEL, VIDHI (DPT, PT)
Entity Type:Individual
Prefix:
First Name:VIDHI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3469 FRANCES BERKELEY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1334
Mailing Address - Country:US
Mailing Address - Phone:757-345-9359
Mailing Address - Fax:
Practice Address - Street 1:6201 CENTREVILLE RD STE 500
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2634
Practice Address - Country:US
Practice Address - Phone:703-263-2095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist