Provider Demographics
NPI:1114267697
Name:PATEL, NIRAV (PT)
Entity Type:Individual
Prefix:
First Name:NIRAV
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5384 DANIELS DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-3006
Mailing Address - Country:US
Mailing Address - Phone:248-752-5123
Mailing Address - Fax:
Practice Address - Street 1:10636 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1969
Practice Address - Country:US
Practice Address - Phone:313-862-1340
Practice Address - Fax:313-862-1329
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
55010314918OtherBOARD OF PHYSICAL THERAPY PHYSICAL THERAPIST LICENCE