Provider Demographics
NPI:1134472913
Name:VAKIL, JINAL KAIRAV
Entity Type:Individual
Prefix:
First Name:JINAL
Middle Name:KAIRAV
Last Name:VAKIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JINAL
Other - Middle Name:DHIREN
Other - Last Name:JHAVERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:808 BERRY ST
Mailing Address - Street 2:APARTMENT NO. 421
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1064
Mailing Address - Country:US
Mailing Address - Phone:317-850-0784
Mailing Address - Fax:
Practice Address - Street 1:4080 WEST BROADWAY AVE STE 300
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-5607
Practice Address - Country:US
Practice Address - Phone:317-850-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist