Provider Demographics
NPI:1164093274
Name:PATEL, DHARA P (PT)
Entity Type:Individual
Prefix:
First Name:DHARA
Middle Name:P
Last Name:PATEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5716 AMPHORA AVE
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2543
Mailing Address - Country:US
Mailing Address - Phone:214-418-0701
Mailing Address - Fax:
Practice Address - Street 1:5350 INDEPENDENCE PKWY STE 110B
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4656
Practice Address - Country:US
Practice Address - Phone:972-587-9404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017736225100000X
TX1345804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist