Provider Demographics
NPI:1215009501
Name:PATEL, KINNARY RAJENDRA (RPT)
Entity Type:Individual
Prefix:
First Name:KINNARY
Middle Name:RAJENDRA
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:KINNARY
Other - Middle Name:SURESH
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:23521 PASEO DE VALENCIA
Mailing Address - Street 2:STE. 210
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-597-0007
Mailing Address - Fax:949-597-0040
Practice Address - Street 1:23521 PASEO DE VALENCIA
Practice Address - Street 2:STE. 210
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-597-0007
Practice Address - Fax:949-597-0040
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19136225100000X
CAAC 4388171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT19136BMedicare PIN
CAWPT19136AMedicare PIN