Provider Demographics
NPI:1164701215
Name:PATEL, AMISHA M (PT)
Entity Type:Individual
Prefix:
First Name:AMISHA
Middle Name:M
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:0 SOUTH 050 WINFIELD ROAD
Practice Address - Street 2:SUITE 120
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1750
Practice Address - Country:US
Practice Address - Phone:630-653-4743
Practice Address - Fax:630-653-4912
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-018562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00999828Medicare PIN
202845192Medicare PIN
ILF400161845Medicare PIN
ILF400117952Medicare PIN