Provider Demographics
NPI:1144573031
Name:PATEL, PAYAL SURESHBHAI
Entity Type:Individual
Prefix:
First Name:PAYAL
Middle Name:SURESHBHAI
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 REFLECTIONS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-5606
Mailing Address - Country:US
Mailing Address - Phone:863-832-2701
Mailing Address - Fax:
Practice Address - Street 1:3110 OAKBRIDGE BLVD E
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-5987
Practice Address - Country:US
Practice Address - Phone:863-648-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002785225100000X
FLPT27974225100000X
TX1217760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist