Provider Demographics
NPI:1255504221
Name:PATEL, KAVITA V
Entity Type:Individual
Prefix:
First Name:KAVITA
Middle Name:V
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAVITA
Other - Middle Name:M
Other - Last Name:MANDVIWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2305 SWIFT BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-5366
Mailing Address - Country:US
Mailing Address - Phone:804-536-4412
Mailing Address - Fax:
Practice Address - Street 1:2305 SWIFT BLUFF DR
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-5366
Practice Address - Country:US
Practice Address - Phone:804-536-4412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028825225100000X
MI5501013058225100000X
VA2305206338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist