Provider Demographics
NPI:1194361816
Name:PATEL, JAIVIKABEN
Entity Type:Individual
Prefix:
First Name:JAIVIKABEN
Middle Name:
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 1:5104 BROOKSIDE DR APT 205
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-1903
Mailing Address - Country:US
Mailing Address - Phone:623-499-5209
Mailing Address - Fax:
Practice Address - Street 1:5104 BROOKSIDE DR APT 205
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-1903
Practice Address - Country:US
Practice Address - Phone:623-499-5209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist